The American Heart Association has issued its 2026 dietary guidance for cardiovascular health optimization and cardiovascular disease risk reduction, superseding its 2021 statement and organizing recommendations into nine discrete features of a heart-healthy dietary pattern rather than nutrient-level targets.

The scientific statement, published in Circulation, identifies poor diet quality as a significant contributor to increased cardiovascular disease (CVD) morbidity and mortality across the full spectrum of risk, from low to high, including patients with established disease. The writing group, chaired by Alice H. Lichtenstein, DSc, FAHA, of Tufts University, emphasizes that the target population is the general US population across the life course, beginning at 1 year of age.

Nine Defining Features

The statement organizes its guidance into nine actionable features:

• adjusting energy intake and expenditure to maintain a healthy body weight

• eating a wide variety of vegetables and fruits

• choosing whole grains over refined grains

• choosing healthy protein sources

• replacing saturated fat with unsaturated fat

• choosing minimally processed foods over ultraprocessed foods

• minimizing added sugars

• reducing sodium intake

• if alcohol is not consumed, do not start; if alcohol is consumed, limit intake.

Body Weight and Physical Activity

The statement cites AHA data showing that obesity currently affects 21% of US pediatric, adolescent, and adult patients and 40% of adults, noting that excess body fat contributes to the development of type 2 diabetes, hypertension, and cardiovascular-kidney metabolic syndrome. Activity targets cited include at least 60 minutes of moderate to vigorous physical activity daily for older pediatric and adolescent patients and at least 150 minutes per week for adults, with muscle-strengthening activities recommended across the life course.

Dietary patterns compatible with weight maintenance and cardiovascular health include the Dietary Approaches to Stop Hypertension diet, Mediterranean-style, pescetarian, and ovo/lacto vegetarian patterns. The statement cautions that some popular weight loss diets may produce short-term benefits but carry uncertain long-term cardiovascular impact and can worsen CVD risk factors.

Vegetables, Fruits, and Whole Grains

Whole or minimally processed vegetables and fruits are identified as core components of heart-healthy dietary patterns, consistently associated with favorable blood lipids, blood pressure, and glycemic control. The statement notes that whole forms provide dietary fiber that juice does not . Frozen and canned varieties are acceptable provided they contain no added sugars or sodium.

For whole grains—defined by the presence of all three grain kernel components (starchy endosperm, inner germ, and outer bran)—a substantial body of observational data from large cohort studies links regular consumption, compared with infrequent intake, to lower risks of CVD, coronary heart disease(CHD), stroke, type 2 diabetes, and metabolic syndrome. Randomized controlled feeding trials further demonstrate that replacing refined grains with whole grains improves cardiovascular risk factors. Diets high in fiber and whole grains are additionally linked to favorable modulation of gut microbiota and a reduction in inflammatory cytokines.

Protein: A Tiered Approach

Noting that the relationship between total protein quantity and cardiovascular health remains uncertain, the statement centers protein recommendations on source rather than amount, divided into four subgroups.

Legumes (beans, peas, and lentils) and nuts, rich in unsaturated fat and fiber, are recommended as good protein sources. Dietary patterns higher in legumes and lower in red and processed meat are associated with lower CVD and CHD risk; patterns higher in nuts are associated with lower CVD and all-cause mortality risk. The statement flags that many plant-based meat alternatives are ultraprocessed foods containing added sugars, sodium, stabilizers, and preservatives, warranting caution.

For fish and seafood, prospective cohort studies link nonfried consumption to lower overall CVD events and myocardial infarction risk, with effects attributed to omega-3 fatty acid content and replacement of saturated-fat–heavy animal proteins. Fish oil supplementation alone has not been demonstrated to lower CVD risk in otherwise healthy adults and in some patients may be associated with an increased risk of atrial fibrillation.

For dairy, the statement acknowledges ongoing debate. One systematic review associates dietary patterns that include low-fat dairy with lower CVD risk; a second, focused specifically on food sources of saturated fat, finds limited evidence that substituting higher-fat with lower-fat dairy results in similar CVD risk, with insufficient evidence to draw conclusions regarding effects on blood lipids, blood pressure, or CVD mortality. The writing group nonetheless upholds prior guidance to replace dairy fat with unsaturated fat sources and to choose nonfat or low-fat dairy products, noting that doing so shifts overall dietary fat composition toward ratios associated with more favorable cardiovascular health.

If red meat is consumed, the statement advises choosing lean, unprocessed cuts, limiting portion size and frequency, and avoiding processed forms. Substitution analyses from large cohort studies find that replacing red and processed meat with legumes, nuts, poultry, dairy, or eggs is associated with lower CHD risk, with stronger associations for processed vs unprocessed red meat.

Unsaturated vs Saturated Fat

Clinical trial evidence consistently shows that replacing sources of saturated fat with polyunsaturated fat—and to a lesser extent monounsaturated fat—reduces low-density lipoprotein cholesterol concentrations, a causal risk factor for CVD. Modeling analyses associate replacement of saturated fat with polyunsaturated fat with reduced CHD risk. Strong evidence supports substituting butter with plant oils and spreads containing predominantly unsaturated fat to lower low-density lipoprotein cholesterol, with limited evidence linking such substitution to lower CVD morbidity and mortality.

Ultraprocessed Foods

The statement identifies the sales of ultraprocessed foods as a growing public health concern, noting that worldwide they are relatively high and projected to increase. Strong evidence links dietary patterns high in ultraprocessed foods to multiple adverse health outcomes, including overweight and obesity, CVD, type 2 diabetes, and all-cause mortality.

Added Sugars

The statement lists all forms of added sugar—including high-fructose corn syrup, maple syrup, honey, and agave nectar—and characterizes evidence supporting minimization of added sugar intake across the life course as strong. Patients consuming 25% or more of energy from added sugars have nearly three times the CVD mortality risk compared with those consuming less than 10% of energy from added sugars, after adjustment for adiposity and other confounders.

Sodium and Potassium

Reducing sodium intake lowers blood pressure in patients with and without hypertension. Higher potassium intake is associated with lower CVD risk, supporting a combined approach of reducing sodium while increasing potassium intake.

Alcohol: Strengthened Language

In a notable update from 2021, the statement sharpens its alcohol guidance. While observational studies have suggested a protective association between low to moderate alcohol intake and CHD risk, newer analyses find no significant association between genetically predicted alcohol consumption and coronary artery disease risk. The relationship between alcohol intake and blood pressure appears linear and progressive, beginning at the lowest intake levels.

The statement concludes that initiation of alcohol intake at any level to improve cardiovascular health is not recommended given uncertainty about net health effects and known harms.

Life Course and Equity Considerations

The statement emphasizes that CVD origins begin early, with dietary patterns recommended starting at 1 year of age. Cultural, socioeconomic, and individual factors should inform dietary counseling and implementation.

Collateral Benefits

Heart-healthy dietary patterns are characterized as meeting nutrient requirements for most patients, reducing the need for dietary supplements except in specific populations such as pregnant women and some older patients. These patterns are also broadly consistent with dietary recommendations for type 2 diabetes, some cancers, kidney disease, and cognitive health.

Disclosures: Writing group chair Alice H. Lichtenstein reports research grants from the US Department of Agriculture and the National Institutes of Health. Additional disclosures are available in the published statement.

The full statement is available at the Circulation journal.