Background: Bread is an important component of the diet in many countries and provides needed nutrients but also typically too much of other nutrients e.g., sodium. We therefore aimed to use linear programing to determine the optimal design of low-cost "heart healthy bread" (HHB) and to compare the results with commercial breads in 15 countries. Methods: Optimization using linear programing focused on achieving set loaf prices (at NZ$1.5 and $3) and for a range of minimal sodium levels. Then within those constraints, levels of alpha-linolenic acid (ALA) were maximized, then dietary fiber, and then polyunsaturated fatty acids. Data from New Zealand (NZ) was used for the HHB designs and comparison nutrient and price data came from breads in 15 high-income countries. Results: The optimized loaf costing NZ$1.50 in ingredients (HHB$1.5) was superior to the commercial white loafs in three out of the eight heart health nutrient categories. The optimized loaf that was high in linseed and cost NZ$3 in ingredients (HHB$3), was nutritionally superior to the commercial loafs with seeds/nuts in six out of the eight heart health categories (i.e., in terms of sodium, potassium, fatty acid ratio and fiber). In terms of value-per-weight, a