Dietary Factors and Risks of Cardiovascular Diseases: An Umbrella Review

Abstract

Unhealthy diet is a significant risk factor for cardiovascular diseases (CVD). Therefore, this umbrella review aims to comprehensively review the effects of dietary factors, including dietary patterns, food groups, and nutrients on CVD risks. Medline and Scopus databases were searched through March 2020. Systematic reviews with meta-analyses (SRMA) of randomized controlled trials (RCTs) or observational studies measuring the effects of dietary factors on CVD risks were eligible. Fifty-four SRMAs, including 35 SRMAs of observational studies, 10 SRMAs of RCTs, and 9 SRMAs of combined RCT and observational studies, were included for review. Findings from the SRMAs of RCTs suggest the significant benefit of Mediterranean and high-quality diets for lowering CVD risk, with pooled risk ratios (RRs) ranging from 0.55 (95%CI: 0.39-0.76) to 0.64 (95%CI: 0.53-0.79) and 0.70 (95%CI: 0.57-0.87), respectively. For food nutrients, two SRMAs of RCTs found that high intake of n-3 polyunsaturated fatty acid (PUFA) significantly reduced CVD risks, with pooled RRs ranging from 0.89 (95%CI: 0.82, 0.98) to 0.90 (95%CI: 0.85-0.96), while evidence of efficacy of n-6 PUFA and combined n-3 and n-6 PUFA were inconsistent. Moreover, results from the SRMAs of RCTs did not find a significant benefit of a low-salt diet and low total fat intake for CVD prevention. For food groups, results from the SRMAs of cohort studies suggest that high intakes of legumes, nuts, and chocolate, as well as a vegetarian diet significantly reduced the risk of coronary heart disease, with pooled RRs of 0.90 (95%CI: 0.84-0.97), 0.68 (95%CI: 0.59-0.78), 0.90 (95%CI: 0.82-0.97), and 0.71 (95%CI: 0.57-0.87), respectively. Healthy dietary patterns had a significant benefit for CVD prevention. With the substitutional and synergistic interactions between different food groups and nutrients, dietary recommendations for CVD prevention should be focused more on healthy dietary patterns than single food groups or nutrients.Nutrients 2020, 12, 1088 2 of 18 (e.g., fruits, vegetables, nuts, whole grains, and legumes), and food nutrients (e.g., sodium, saturated fat, and monounsaturated fat). However, most evidence has focused on dietary fats, due to the established relationship between serum cholesterol level and CVD risks. Previous evidence on the association between dietary fat intake and CVD prevention is inconsistent and is still being debated. For instance, in 2017 the American Heart Association (AHA) recommended lowering saturated fat intake and replacing it with unsaturated fat, especially polyunsaturated fatty acids (PUFA), for CVD prevention [5]. However, some systematic reviews and meta-analyses (SRMA) of randomized controlled trials (RCT) did not show a significant benefit of PUFA for reducing CVD risks [6,7], and the findings from an 18-country cohort study also concluded that "total fat and types of fat were not associated with CVD" [8]. Similarly, findings from SRMAs [9-12] of the effects of other dietary factors, such as vegetables, fruits, and fibers on CVD risk...

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