To respond to the question of the best "heart-healthy" diet, we reviewed the effects of common diets on
lipids, their efficacy, advantages, and limitations. The
high-protein, low-carbohydrate diet is effective for
weight loss over the short term, but its long-term benefits remain unproved. The very
low-fat diet decreases levels of total and
low-density lipoprotein cholesterol and, with lifestyle modifications, may slow progression of
coronary atherosclerosis. The high-
protein and very
low-fat diets are difficult to follow over the long term. The American Heart Association diet, which is rich in fruits, vegetables, and nuts, decreases blood pressure and may be acceptable to most patients. However, it is rich in
carbohydrates and may not be suitable for patients who are obese and/or have high levels of
triglycerides. In such patients, diet based on foods with a low glycemic index may be an alternative. There is also immense interest in the
Mediterranean diet, which is acceptable to most patients, may decrease some
biomarkers of
coronary atherosclerosis, and may decrease cardiovascular events and death. Despite these options, there is no "fits all" dietary recommendation for prevention of
coronary heart disease. Importantly, dietary discretion is only 1 part of lifestyle changes, such as exercise and smoking cessation.