Prioritising healthy eating to prevent cardiovascular diseases

With cardiovascular diseases (CVDs) now the leading cause of death globally, prioritising management of the condition and preventative measures is critical to enhancing our quality of life and longevity. This is a key goal of World Heart Day campaign urging for small lifestyle, including dietary, changes to better manage our heart health and beat CVDs. Improving our diet by eating a variety of whole grains, plenty of fruits and vegetables, nuts and legumes, while limiting excess consumption of fat, salt and sugars, is critical for CVD prevention. Alternatives to sugars, such as low/no calorie sweeteners, have a role to play in sugar reduction and can be part of a healthy diet and lifestyle for a good cardiometabolic health.

CVD is a major health issue

Over 50 million people are living with CVDs in the EU, and over five million new cases of CVD are diagnosed every year, causing millions of Europeans to lose their lives due to heart attacks or strokes. It has been termed as ‘EU’s biggest killer’ (European Society of Cardiology) but it is also the leading cause of death globally (World Health Organisation; World Heart Federation). The impact of CVDs on health, society and the economy is profound. It affects quality of life, impacts productivity, and increases dependency on family and societal support.

World Heart Day, celebrated every year on 29 September, provides an important reminder about some simple lifestyle adjustments that people can make to help them lead healthier lives.

The need to act

Addressing CVDs is high on the EU agenda, with political groups across the spectrum identifying it as a priority. Amongst other health priorities, the European Commission has committed to improving preventative health in the 2024-2029 political guidelines, including on CVDs. The Hungarian Presidency of the Council’s concept paper highlights the critical role of CVD prevention, advocating for an environment that favours physical activity, healthy nutrition, mental health and well-being, while also combating significant risk factors such as tobacco and alcohol consumption. An upcoming European Action Plan will further address prevention, innovation and treatment options.

A healthy diet is key for prevention

At least 80% of deaths from CVDs could be avoided through the adoption of healthier lifestyles (The Economist Impact), including ceasing smoking, reducing alcohol use, combating unhealthy diets and obesity, and increasing physical activity (World Health Organisation).  When it comes to food and nutrition, making progress on reformulation frameworks that aim to reduce excess salt, saturated fat and sugars in food is key.

Eating a healthy diet including a variety of vegetables, fruits, legumes, nuts, and whole grains, while being low in salt, fat and sugars is key in protecting cardiometabolic health. Limiting excess intake of free sugars is globally recommended as part of a healthy diet, particularly for the prevention and management of cardiometabolic diseases such as CVDs and type 2 diabetes (World Health Organisation).

The role of low/no calorie sweeteners

“Low/no calorie sweeteners (LNCS) can help individuals achieve sugar intake reduction while following an overall healthy and tasteful diet, including for people with, or at risk of, cardiometabolic diseases” said Laurent Oger, Director General of the International Sweeteners Association (ISA). With our appetite for sweetness being innate, LNCS are a useful strategy to help us manage our desire for sweet treats without the caloric load and other adverse effects of sugars. If used instead of their regular-calorie versions, food and drinks sweetened with LNCS allow people to keep enjoying sweet taste while reducing sugars and calorie intake, improving diet satisfaction and adherence to an overall healthy dietary pattern.

Clinical research shows that, when used to replace sugars, LNCS have a neutral or modestly beneficial effect on cardiometabolic risk factors such as glycaemic control, blood pressure and lipid levels, liver enzymes, uric acid, body weight and liver fat (McGlynn et al., 2022). The beneficial impact of LNCS on heart health markers such as liver fat, fat mass and body weight are important to look at. LNCS can help as replacing sugar with LNCS lowers the caloric content of foods and drinks and, importantly, its sugar content.

Systematic reviews and meta-analyses of randomised controlled trials (RCTs) consistently show that LNCS, when used instead of sugar, can support lower energy intake and in turn help with weight control over time (WHO, 2022; Laviada-Molina et al, 2020; Rogers and Appleton, 2021). The benefit, of course, depends on the amount of sugars and calories replaced in the diet by the use of LNCS.

When global and European rates of CVDs continue to rise, it is essential to expand and integrate tools into public health promotion strategies. In the context of World Heart Day, a healthy diet and nutrition should be prioritised in the EU CVD Action Plan and tools for sugar reduction such as low/no calorie sweeteners should not be left out of these discussions.