Diet, inflammation, and cardiovascular disease

Cardiovascular diseases (CVDs), particularly ischemic heart disease and stroke, which account for over 72% of all CVDs, remain among the major causes of disability and death worldwide. In developed countries, rates increased for most of these diseases from the end of the Industrial Revolution until a couple of decades after World War II, after which they fell for many decades. Research conducted over this time has identified diet, especially Western-style diets that are calorie-dense and nutrient-sparse and strongly proinflammatory, as being the primary cause of CVD. We begin with a description of the history of CVD, which coincides with our general knowledge about inflammation and places current knowledge in an understandable context. This also introduces the concept of vulnerable populations that may be particularly susceptible to the effect of diet in relation to CVD. We discuss specific dietary factors (i.e., foods and nutrients) and, more importantly, patterns of intake that are strongly associated with both the incidence and mortality of CVD. In this regard, we focus especially on the Mediterranean diet, the DASH diet, and the vegetarian diet, as dietary patterns rich in fruits and vegetables, containing sufficient dietary fiber, but being low in saturated fat and refined carbohydrates. These diets have been promoted to offer protection against CVD. We further discuss and present specific inflammation-related mechanisms of action that are unique to the foods contained in these diets. Prominent among characteristics of these foods, including secondary plant compounds that influence cellular signaling cascades that, in mechanistic studies, have been shown to exert antiinflammatory and antioxidant effects. Though we discuss all CVDs, we emphasized ischemic heart disease and stroke (both ischemic and hemorrhagic), which account for most of the incidence, disability, and mortality from CVD worldwide.