Cardiovascular disease Cardiovascular disease (CVD), is a group of conditions that includes stroke and heart disease. CVD kills one in three people in the UK. While some contributing factors can't be altered, we can change our lifestyle.

In this article

Risk factors you can change Dietary changes Fat

Essential fatty acids Stanols and Sterols Fruit and vegetables

Wholegrains and fibre Alcohol Soya protein

CVD is caused by a build-up of fatty streaks and cholesterol in the blood vessels.

Natural wear and tear to blood vessels makes it easier for fatty cholesterol to leak in and get stuck to the artery walls. This build-up causes the arteries to narrow, reducing the heart's ability to pump blood through them to the body. If they become completely blocked, it will cause a heart attack or a stroke if the blockage occurs in the brain's blood vessels.

Importantly, not all cholesterol is bad. There are two types of cholesterol in the bloodstream: LDLs and HDLs. LDLs create the build-up in arteries, while high HDL levels are a good sign that you're not at risk of CVD.

Some risk factors are strongly associated with CVD but are potentially reversible or can be modified:

• cigarette smoking
• increased levels of LDL cholesterol
• high triglycerides (caused by the build up of fats derived from foods eaten or made in the body from other energy sources)
• low HDL cholesterol
• being overweight
• large waist circumference (being 'apple-shaped')
• high blood pressure
• inactivity
• diabetes

Making small changes to your diet is one of the simplest and most effective ways to reduce your risk of CVD. You can do this by

• reducing fat in your diet, especially saturated and trans-fats
• eating more fruit and vegetables, wholegrain food and soluble fibre
• drinking alcohol in moderation
• reducing salt to maintain a lower blood pressure

Reducing the proportion of fat in your diet, especially saturated fat, can help to reduce blood cholesterol levels. There's a strong link between high blood cholesterol levels and the risk of heart disease. For those who don't have CVD or aren't considered to be at high-risk of CVD, normal blood cholesterol levels are below 5mmol/litre. This can be measured by your GP. People with average energy needs should aim to consume no more than 70g/day of fat and less than 20g/day of saturated fat.

Trans-fatty acids are a particular kind of fat that are naturally occurring in meat and dairy products but may also be produced when plant-based oils are hydrogenated to produce solid spreads, such as margarines. They're often found in confectionery and processed food like pastry, biscuits and cakes. They've been found to have the same effect on cholesterol levels as saturated fat and should be avoided as much as possible. Thankfully, many manufacturers have now modified processing techniques to keep these fats to a minimum. Check labels for hydrogenated fats.

When reducing total fat, it's important not to cut out the heart healthy fats from your diet including mono and poly-unsaturated fats and omega-3, mostly found in plant and fish oils.

How to modify your fat intake:

• use butter and other spreads sparingly
• choose lean cuts of meat or trim fat off
• grill, bake or steam food rather than frying
• swap saturated fats such as butter for unsaturated oils such as sunflower, rapeseed or olive oil
• limit your intake of trans-fats from processed food
• eat two to three portions of oily fish each week (eg sardines, mackerel, fresh tuna, salmon)

Essential fatty acids such as omega-3s, which are found in oily fish, have been shown to reduce the risk of CVD by lowering blood triglycerides, reducing blood clotting and regulating heart rhythm. For general heart health try to eat two portions of fish per week, one of which should be oily.

Certain plant-derived compounds, called stanol or sterol esters have been shown to reduce cholesterol levels. Spreads, yoghurts, drinks and soya 'dairy alternatives' are now available containing these products. These sterol enriched foods may be particularly useful for those with raised blood cholesterol which has remained elevated even after making other dietary changes. Clinical trials show that when used regularly, they can reduce high cholesterol levels.

Fruit and vegetables are rich in many essential nutrients including vitamins C and E and carotenoids (which are all antioxidants). They may help to protect the heart by limiting the damaging effects of cholesterol on body tissues. Aim for at least five servings of fruit and vegetables a day. (See the Fruit and Vegetables article for more information on what a serving is.)

Studies of large groups of people in the US have shown that diets rich in wholegrain food can reduce the risk of CVD by up to 30 per cent. You can include wholegrain food in every meal by choosing wholemeal bread and wholegrain varieties of pasta and rice.

Soluble dietary fibre, found in oats, beans and pulses, can help to lower LDL cholesterol. These foods should be included as part of an overall healthy balanced diet, at least two to three times each week.

Consuming moderate amounts of alcohol - between one and two units a day - has been found to reduce the risk of CVD. Alcohol can increase HDL cholesterol and makes it less likely that clots will form. However, high intakes of alcohol are associated with increased risk. It's also worth noting that saving up your weekly units for a weekend binge doesn't offer the same benefits.

A diet that includes at least 25g of soya per day has been associated with reductions in LDL cholesterol and CVD. Soya isoflavones in particular have been shown to reduce CVD risk as they inhibit the growth of cells that form artery-clogging plaque. Soya protein is also an excellent substitute for meat and is available in a convenient and tasty form in many ready-made meals. Another good source of soya protein is soya milk and yoghurt.

The British Heart Foundation has an excellent range of resources giving information about reducing your risk of cardiovascular disease.

This article was last medically reviewed by the MRC Human Nutrition Research in July 2008.
First published in March 2001.