By Anna Horner | News & Views

Cardioprotective diets are important for more than just lowering LDL cholesterol, says Kyla Lara-Breitinger, MD, MS, a cardiologist at Mayo Clinic. According to Dr. Lara-Breitinger, the quality of food and its relationship with cardiovascular health are crucial considerations for cardiac rehabilitation (CR) patients. However, she acknowledges how difficult it can be for CR practitioners to navigate the vast amount of available information about nutritional quality and dietary patterns. Distinguishing between robust, science-backed data and fads or trends can also be a challenge, she adds.

Dr. Lara-Breitinger says CR practitioners should understand where food comes from and how socioeconomic status affects what a person eats. “If we all had an abundance of income, it would be easier to have a very healthy diet of palatable foods that are interesting and ones we don't get tired of,” she explains. “But for most people, thinking about work, stress, family, and other things that require much more priority, they go for the easiest thing to eat that makes them feel full so that they have energy.”

She notes that recommending cardioprotective diets isn’t a matter of simply handing a patient a pamphlet that tells them what to do. “CR practitioners have to learn how to customize the information for the patient,” Dr. Lara-Breitinger explains. “For example, a stay-at-home parent who has multiple toddlers in the house might be more likely to eat the same food than to make a second meal. Somebody who travels for work might eat out a lot and take clients out. They don't necessarily have control over where and what they eat. So, thinking about habits and choices given what’s available to you can go a long way.”

One of the most important nutritional considerations is what Dr. Lara-Breitinger calls “the lowest-hanging fruit,” namely minimizing servings of ultra-processed foods, which contain many preservatives and additives. “Each additional serving of ultra-processed foods on top of the baseline 7.5 servings per day for the average American is associated with anywhere from a 5% to 9% increase in cardiovascular-related mortality and comorbidity,” she reports.

Adequate protein intake is another top nutritional consideration. “As we get older, we naturally will lose muscle mass, so maintaining muscle mass requires eating enough protein and then using the muscle to build strength,” notes Dr. Lara-Breitinger. “The use of GLP-1 receptor agonists is on the rise and is transforming how we treat obesity as a chronic and relapsing disease. It's very complex, with genetics, hormone regulation, and the types of medications you're taking potentially make it difficult to lose weight. When I have patients who restrict their food intake because they're on these medications, I really urge proteins as the first thing they consume, followed by healthy carbs.” She says this makes it important for CR practitioners to understand the differences in types of protein related to saturated fat and the differences in protein intake for fatty types of meat, like beef, versus lean poultry, seafood, and plant protein.

Dr. Lara-Breitinger concludes, “What it comes down to is not feeling overwhelmed and understanding that wherever you live, there are healthy options within that radius. It's about finding food that is sustainable, fresh, and available in the area where you live while paying attention to saturated fat and protein intake.”