The Best Post-Heart Attack Diet

Evidence Points to the Mediterranean Diet

Mediterranean Diet
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Many studies have shown that eating a healthy diet is important for reducing your risk of developing coronary artery disease (CAD). But what if you already have CAD, and perhaps have even had a myocardial infarction (heart attack), angina, or acute coronary syndrome? Is diet still important?

Until relatively recently, dietary recommendations for people with CAD were based more on faith than on science.

This is because firm scientific evidence that a healthy diet can substantially improve cardiac outcomes in people who already have CAD was lacking. In the last few years, however, the picture has become clearer.

Current dietary recommendations from the American Heart Association and the European Society of Cardiology for people with CAD emphasize eating lots of fresh fruits and vegetables, and avoiding saturated fats, trans fats, and high-fat dairy products. In addition, the Europeans specify eating oily fish at least twice a week.

Notably, these general dietary guidelines can perhaps be best achieved with the Mediterranean diet.

What Is the Mediterranean Diet?

The Mediterranean Diet (so named because it reflects the traditional eating habits of people who live in the Mediterranean regions) is largely a plant-based diet (fruits, vegetables, legumes, nuts and whole grains) with moderate servings of cheese, eggs and yogurt, and with a few portions each week of fish and other seafood, and poultry.

Olive oil and red wine (a glass or two a day) are also featured in a typical Mediterranean diet.

New Evidence Promoting the Mediterranean Diet

Recently, two studies have been published that bolster evidence that the Mediterranean diet is helpful in preventing CAD, and in improving outcomes in people who already have CAD.

The PREDIMED trial compared two varieties of the Mediterranean diet with a simple low-fat diet—the type of diet most typically recommended for people with CAD over the last 25 years—in more than 7,000 people who were at high risk for CAD. After a follow-up period of nearly five years, cardiovascular outcomes (that is, the incidence of heart attack, stroke or heart-related death) were significantly better in the two groups randomly assigned to the Mediterranean diets.

In a second trial, more than 30,000 people 55 years of age or older with CAD (or with diabetes with cardiovascular complications) were grouped according to their dietary habits, and followed for an average of 56 months. Those who followed a Mediterranean-style diet had a significantly lower incidence of heart attack, heart failure, stroke or cardiovascular death.

The Bottom Line

While large, prospective, randomized clinical trials with the Mediterranean diet specifically enrolling people who already have CAD are lacking, the accumulated body of evidence in favor of a Mediterranean diet appears strong.

If you want to follow a Mediterranean diet, here are the keys:

  • Avoid processed foods.
  • The foundation of your diet should be plant-based foods. These should include plenty of fruits, vegetables, and legumes. Grains in your diet (breads and pasta) should be whole grains. Add a handful of nuts per day.
  • Avoid margarines and butter, and use olive oil or canola oil instead. (Dip your whole grain bread in olive oil instead of butter.)
  • Limit red meat to once or twice a month.
  • Eat fish and poultry at least twice a week.
  • If you can do so without risk of abuse, consider having a glass of red wine with dinner.


Perk J, De Backer G, Gohlke H, et al. European Guidelines on cardiovascular disease prevention in clinical practice (version 2012). The Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of nine societies and by invited experts). Eur Heart J 2012; 33:1635.

Estruch R, Ros E, Salas-Salvad¢ J, et al. Primary prevention of cardiovascular disease with a Mediterranean diet. N Engl J Med 2013; 368:1279.

Dehghan M, Mente A, Teo KK, et al. Relationship between healthy diet and risk of cardiovascular disease among patients on drug therapies for secondary prevention: a prospective cohort study of 31 546 high-risk individuals from 40 countries. Circulation 2012; 126:2705.

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