2026 AHA Dietary Guidance to Improve Cardiovascular Health

Authors, Journal, Affiliations, Type, DOI

• Alice H. Lichtenstein (Chair), Amit Khera (Vice Chair), Cheryl A.M. Anderson, Lawrence J. Appel, Dana M. DeSilva, Christopher Gardner, Frank B. Hu, Daniel W. Jones, Kristina S. Petersen; on behalf of the American Heart Association
• Circulation, 2026;153:e00–e00
• Affiliations: Tufts University (Lichtenstein), UT Southwestern (Khera), UCSD (Anderson), Johns Hopkins (Appel), AHA (DeSilva), Stanford (Gardner), Harvard (Hu), University of Mississippi (Jones), Penn State (Petersen)
• Type: AHA Scientific Statement (supersedes 2021 edition)
• DOI: 10.1161/CIR.0000000000001435

Overview

This 2026 AHA Scientific Statement supersedes the 2021 edition and provides updated food-based cardiovascular health guidance organized around 9 dietary pattern features applicable across the life course. The statement reinforces a whole-dietary-pattern approach over individual nutrient focus, emphasizing that heart-healthy eating patterns should be adopted early in life and maintained throughout adulthood. Key updates include a substantially harder stance on alcohol — Mendelian randomization data negate prior observational protective associations, and initiation at any level is not recommended — and expanded evidence against ultraprocessed foods. The statement also clarifies that dietary fish reduces CVD risk while fish oil supplementation does not, and may increase atrial fibrillation risk.

Keywords

AHA Scientific Statements, cardiovascular diseases, diet, food, nutrition policy, risk reduction behavior

Key Takeaways

Dietary Principles

• Focus on overall dietary patterns, not single foods or nutrients; patterns encompass all foods and beverages throughout the day
• Heart-healthy dietary pattern adoption should begin at age 1 and be maintained across the life course; dietary habits are shared and transmitted within households; key inflection points for dietary change include childhood, adolescence, and young adulthood
• Guidance applies regardless of where food is procured (home, restaurants, institutional settings)

Feature 1: Energy Balance and Healthy Body Weight

• Obesity affects 21% of US children/adolescents and 40% of adults; excess body fat contributes to T2DM, hypertension, and cardiovascular-kidney-metabolic syndrome
• Physical activity: ≥60 min/day moderate-vigorous for children/adolescents; ≥150 min/week for adults; plus muscle-strengthening throughout life course
• Validated heart-healthy dietary patterns (DASH, Mediterranean, pescetarian, ovo/lacto vegetarian) support healthy body weight when implemented as intended
• Some popular weight-loss diets (e.g., ketogenic) have uncertain long-term CV impact and may worsen risk factors (dramatic LDL-C elevation reported in case series)

Feature 2: Vegetables and Fruits

• Core components of all heart-healthy patterns; consistently associated with favorable blood lipids, BP, and T2DM control
• All forms acceptable (fresh, frozen, canned) preferably without added sugars or sodium; whole fruit preferred over juice (fiber content)

Feature 3: Whole Grains

• Whole grains (whole wheat, oats, brown rice, quinoa, barley, rye) contain all three grain kernel components (endosperm, germ, bran); provide fiber, vitamins, minerals, and bioactive compounds
• Regular whole-grain intake associated with lower CVD, CHD, stroke, T2DM, and metabolic syndrome risk; favorable effects on BP, blood lipids, and glycemic control confirmed in large cohort studies and RCTs replacing refined grains
• Whole grains modulate gut microbiota favorably and reduce inflammatory cytokines

Feature 4: Healthy Protein Sources

• Plant proteins first (legumes and nuts): Dietary patterns higher in legumes and lower in red/processed meat → lower CVD and CHD risk; nuts associated with lower CVD and all-cause mortality risk; plant-based meat alternatives often ultraprocessed with high sodium/additives — use with caution
• Non-fried fish and seafood: Associated with lower overall CVD events and MI risk (prospective cohort data); attributed to omega-3 FA content and replacement of saturated-fat-rich animal protein
• Fish oil supplements: NOT demonstrated to lower CVD risk in otherwise healthy adults; may be associated with increased AF risk — this is a critical distinction from dietary fish
• Dairy: Prefer low-fat or fat-free over full-fat; evidence for low-fat dairy and lower CVD risk exists but dairy fat controversy persists; fermented dairy (yogurt, kefir) may benefit gut microbiota (long-term clinical implications unclear); current guidance: continue to replace dairy fat with unsaturated fat sources
• Red and processed meat: Replace with plant sources → improved CVD risk factors; processed meat (cured/smoked/salted/preserved: bacon, sausage, deli meats) carries stronger risk than unprocessed; choose lean cuts, limit portion size and frequency

Feature 5: Unsaturated Fat Over Saturated Fat

• Clinical trial evidence consistently shows replacing saturated fat with polyunsaturated fat reduces LDL-C, a causal CVD risk factor; modeling analyses confirm reduced CHD risk
• Sources of saturated fat: animal fats (butter, beef tallow), tropical oils (coconut oil, palm oil, cocoa butter)
• Sources of unsaturated fat: nontropical plant oils (soybean, canola, olive oils); these should replace animal and tropical fats in food preparation
• Replacing butter with plant oils lowers LDL-C; replacing tropical oils with nontropical plant oils lowers LDL-C

Feature 6: Minimally Processed Over Ultraprocessed Foods

• Ultraprocessed foods (Nova classification): industrial processing + cosmetic additives + ingredients absent from home cooking; typically high sodium and added sugars; fiber and nutrients removed
• Strong evidence: high ultraprocessed food intake → overweight/obesity, CVD, T2DM, and all-cause mortality risk; global sales projected to rise
• Mechanistic basis for ultraprocessed food harms is limited due to heterogeneity of the Nova category; evidence is consistent but causality is still debated

Feature 7: Minimize Added Sugars

• Added sugars: all forms added during processing — table sugar, corn syrup, HFCS, honey, molasses, fruit concentrates, dextrose, fructose, glucose, etc.
• Dietary patterns high in added sugars → adverse CV health and higher CVD risk; sugar-sweetened beverages linked to obesity, T2DM, CHD, and CV mortality
• Adults consuming ≥25% of energy from added sugars have ~3× higher CVD mortality vs. those consuming <10% (adjusted for adiposity)

Feature 8: Sodium Reduction and Potassium Increase

• Sodium raises BP; potassium lowers BP — they have opposite effects on the leading modifiable risk factor for preventable mortality
• Sodium reduction lowers BP in both hypertensive and normotensive individuals; effects greatest in Black individuals, older adults, hypertensives, and diabetics; lower sodium associated with blunted age-related BP rise and lower CVD risk
• Higher potassium intake (from vegetables and fruits) associated with lower CVD risk; potassium-enriched salt substitutes reduce BP and CVD events but warrant caution in those with impaired urinary potassium excretion (hyperkalemia risk)
• Combined approach (↓sodium + ↑potassium) is the most effective dietary strategy for BP management

Feature 9: Alcohol

• Mendelian randomization studies do NOT confirm the prior observational protective association of low/moderate alcohol with CHD; no significant association between genetically predicted alcohol and CAD risk
• Alcohol and BP have a linear, progressive relationship beginning at the lowest intake levels; 2025 AHA/ACC HT guideline recommends avoiding alcohol for hypertension prevention/treatment
• Initiation of alcohol at any level to improve CV health is not recommended given uncertain net health effects and deleterious effects on other outcomes (cancer, BP)
• Binge and heavy drinking: strongly discouraged — well-established harms across most CVD forms including hypertension

Additional Benefits of Heart-Healthy Dietary Patterns

• Fulfills essential nutrient requirements for most individuals; dietary supplements not needed except in pregnant women, some older adults, and those on restricted diets
• Rich in dietary fiber: supports GI function, gut microbiota, blood glucose regulation; associated with reduced CVD, T2DM, and colorectal cancer risk
• Dietary cholesterol no longer a primary CVD target; moderate egg consumption compatible with heart-healthy diet
• Consistent with dietary recommendations for T2DM, some cancers, kidney disease, and cognitive health

Limitations of the Document

• Applies to the general US population; cultural, socioeconomic, and individual contextualization required for patient counseling
• Evidence for mechanisms linking ultraprocessed foods to adverse outcomes is limited due to heterogeneity of the Nova category
• Dairy fat controversy remains unresolved: insufficient evidence to draw conclusions about higher-fat vs. lower-fat dairy on CVD mortality
• Fish oil supplement AF risk signal is based on pooled analyses; magnitude not precisely quantified
• No dedicated pharmacological guidance; statement focuses on food-based strategies only

Key Concepts Mentioned

• concepts/Heart-Healthy-Dietary-Patterns — the 9-feature AHA framework summarized in this source
• concepts/Dyslipidemia-Management — dietary fat quality (saturated vs. unsaturated) and LDL-C reduction
• concepts/ASCVD-Risk-Assessment — diet as a primary prevention lifestyle modifier

Key Entities Mentioned

• entities/Atrial-Fibrillation — fish oil supplementation associated with increased AF risk; alcohol dose-dependently linked to AF
• entities/Heart-Failure — sodium restriction and potassium intake relevant to HF congestion management
• entities/Hypertension — sodium, potassium, and alcohol guidance aligned with 2025 AHA HT guideline

Wiki Pages Updated

• Created: wiki/concepts/Heart-Healthy-Dietary-Patterns
• Updated: wiki/concepts/Dyslipidemia-Management
• Updated: wiki/entities/Atrial-Fibrillation
• Updated: wiki/entities/Heart-Failure
• Updated: wiki/wikiindex.md
• Updated: wiki/sourceindex.md