Choosing Foods for a Post-Heart Attack Diet

Cardiovascular experts all agree 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? How important is the right diet for you?

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.

These general dietary guidelines can perhaps be best achieved with the Mediterranean diet.

Olive oil, bread, herbs - components of the Mediterranean diet
eleonora galli / Moment / Getty Images

What Is the Mediterranean Diet?

There is no “official” definition of a Mediterranean diet. This is the name chosen to reflect the traditional eating habits of people who live in the Mediterranean regions. A Mediterranean diet is largely a plant-based diet that includes lots of fruits, vegetables, legumes, nuts, and whole grains, along with moderate servings of cheese, eggs, and yogurt, and with a few portions each week of fish and other seafood, and poultry. Particularly characteristic of a Mediterranean diet is the inclusion of plenty of olive oil (a major source of monounsaturated fatty acids), along with a glass or two a day of red wine.

New Evidence Promoting the Mediterranean Diet

In recent years, studies have been published that bolsters 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 who were known to have either 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.

A Word From Verywell

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 margarine 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.
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2 Sources
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  1. 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(13):1635-701. doi:10.1093/eurheartj/ehs092

  2. Estruch R, Ros E, Salas-salvadó J, et al. Primary prevention of cardiovascular disease with a Mediterranean diet supplemented with extra-virgin olive oil or nuts. N Engl J Med. 2018;378(25):e34. doi:10.1056/NEJMoa1800389

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