**Background:** Cardiovascular disease (CVD) is the leading cause of mortality worldwide, with prevalence doubling from 1990 to 2019 and deaths rising from 12.1 million to 18.6 million over the same period. Projections indicate approximately 23 million CVD deaths by 2030. While pharmacotherapies reduce CVD risk by only 20–30%, adoption of healthy lifestyle choices reduces myocardial infarction risk by 81–94%. Nutrition is identified as the most important behavioral factor for preventing premature CVD death and disability, surpassing smoking abstinence and physical activity. The review examines the pathophysiological links between diet, inflammation, atherosclerosis, and hypertension, and evaluates evidence for specific dietary patterns.
**Methods:** This is a narrative review synthesizing findings from multiple landmark studies and meta-analyses. Key studies discussed include the ATTICA study (2001–2012, Athens, Greece), the Lyon Heart Study (mean follow-up 46 months), the Framingham Offspring Study (18 years follow-up), the Physicians' Health Study I (1982–2008, 20,900 men), the French NutriNet-Santé cohort study, and a 2012 meta-analysis by Huang et al. (124,706 participants). The review also cites the work of Tyrovolas et al. on anti-inflammatory diets and successful aging, Trichopoulou et al. (1995) on Mediterranean diet and survival, and Greco et al. (275 ACS patients, up to 5 years follow-up) on psychological factors and dietary behavior.
**Key Results:** The ATTICA study demonstrated that combining the Mediterranean diet with physical activity attenuates inflammation in healthy individuals and translates to lower CVD incidence. The Lyon Heart Study showed significant reductions in all composite outcomes (cardiac death, non-fatal MI, and secondary endpoints) in the Mediterranean diet subgroup over 46 months. The DASH diet decreased incident CVD by 20%, coronary heart disease by 21%, stroke by 19%, and diabetes by 18% in prospective cohort studies. The Framingham Offspring Study found each additional daily serving of ultra-processed foods was associated with a 7% increase in CVD risk over 18 years. The NutriNet-Santé cohort reported a 12% increased CVD risk with higher ultra-processed food consumption. The Huang et al. meta-analysis showed significantly lower CAD mortality in vegetarians versus non-vegetarians. The Physicians' Health Study I associated consumption of breakfast cereals, fruits, and vegetables with lower lifetime risk of heart failure. Tyrovolas et al. reported that a low anti-inflammatory diet was associated with lower levels of successful aging regardless of age, gender, residence, smoking, and waist circumference. Trichopoulou et al. found strong association between Mediterranean diet adherence and overall survival, with main contributors being moderate ethanol consumption, low meat consumption, and high vegetable, fruit, and nut consumption. Greco et al. found that more anxious ACS patients maintained healthier dietary behavior over time. A Chinese cohort of 29,072 older individuals showed that healthy dietary habits were associated with slower memory decline over 10 years, independent of apolipoprotein E genetic status.
**Clinical Implications:** The review strongly supports that healthy dietary patterns—particularly Mediterranean and DASH diets—are cornerstone interventions for both primary and secondary CVD prevention. These dietary approaches reduce risks of diabetes, hypertension, stroke, and obesity. The evidence indicates that nutrition should be prioritized as a non-pharmacological agent in CVD prevention, with educational strategies needed to emphasize dietary habits for healthy aging. The review also highlights socioeconomic disparities in diet quality that contribute to higher CVD prevalence in lower socioeconomic groups, suggesting that educational interventions targeting eating behaviors are crucial for reducing CVD burden.