The Best Diet for Heart Health, Ranked by the Evidence

There is no shortage of diets claiming to protect the heart. Low-carbohydrate plans promise better blood glucose, low-fat diets focus on cholesterol, and plant-based programs remove entire food groups. However, the strongest evidence does not support one restrictive set of rules. It consistently points towards eating patterns built around vegetables, fruit, wholegrains, legumes, nuts, fish and unsaturated fats.

Based on cardiovascular outcomes, improvements in major risk factors and long-term practicality, the Mediterranean diet ranks as the best overall diet for heart health. The DASH diet follows closely, particularly for lowering blood pressure. Pescatarian and well-planned vegetarian diets can also be highly protective, while low-fat and low-carbohydrate diets depend much more heavily on the quality of the foods chosen.

The Mediterranean diet has the strongest overall combination of clinical evidence, cardiovascular benefits and long-term flexibility.

It is based on vegetables, fruit, legumes, wholegrains, nuts, seeds, fish and extra virgin olive oil. Poultry, eggs and dairy can be included in moderate amounts, while processed meat, large servings of red meat, refined carbohydrates and highly processed foods are limited.

The PREDIMED trial provides some of the most influential evidence. It studied people at high cardiovascular risk and found fewer major cardiovascular events among those following a Mediterranean diet supplemented with extra virgin olive oil or nuts than among those advised to follow a reduced-fat diet.

Its value is not limited to one nutrient. The Mediterranean pattern can improve the overall quality of dietary fat, increase fibre, reduce reliance on highly processed foods and support healthier blood pressure, glucose and cholesterol.

It is also adaptable. Australians do not need to eat traditional Greek or Italian meals at every sitting. A Mediterranean-style dinner could be grilled fish with vegetables and barley, a lentil curry with brown rice, or a wholegrain pasta containing tomatoes, beans and olive oil.

Wine is not required. Although alcohol appears in some traditional descriptions of the Mediterranean diet, people should not begin drinking for heart health.

The Dietary Approaches to Stop Hypertension diet, better known as DASH, was developed specifically to help lower blood pressure.

It emphasises vegetables, fruit, wholegrains, legumes, nuts, seeds, fish, poultry and lower-fat dairy. It also limits sodium, processed meat, sweets, sugary drinks and foods high in saturated fat.

The DASH diet has strong evidence supporting improvements in blood pressure and other heart health markers. However, compared with the Mediterranean diet, there is currently more long-term research showing the Mediterranean approach’s impact on overall cardiovascular outcomes.

This does not mean the DASH diet is ineffective for heart health. It remains a well-supported eating pattern that can help improve key risk factors. Research is continuing to understand how these improvements translate into long-term heart health and overall wellbeing.

The diet supplies potassium, magnesium, calcium and fibre, which support blood pressure regulation. It also reduces sodium by limiting packaged foods, takeaway meals, processed meats, salty snacks and high-sodium sauces.

DASH does not require food to taste bland. Garlic, pepper, lemon, vinegar, chilli, fresh herbs and salt-free spice blends can provide flavour while reducing reliance on salt.

For many people, the best approach is not choosing between DASH and Mediterranean eating. The two patterns overlap considerably and can be combined.

A pescatarian diet is predominantly plant-based but includes fish and seafood. It can closely resemble Mediterranean eating when it contains plenty of vegetables, legumes, wholegrains, nuts, seeds and unsaturated oils.

Fish provides protein without the amount of saturated fat found in many fatty or processed meats. Oily fish such as salmon, sardines, trout and mackerel also supply long-chain omega-3 fats, which can help lower triglycerides.

Replacing sausages, bacon and fatty meat with fish or legumes can improve the overall quality of the diet. The benefit comes from both what is added and what is displaced.

A pescatarian diet is not automatically healthy. Battered fish, hot chips, white bread, confectionery and highly processed meat-free products can technically fit within it. The protective effect depends on choosing mostly minimally processed foods rather than simply removing meat.

Vegetarian diets can support heart health when they are based on whole plant foods. Legumes, tofu, tempeh, vegetables, fruit, wholegrains, nuts and seeds provide fibre and generally contain less saturated fat than diets centred on fatty meat.

Soluble fibre from oats, barley, beans, lentils and some fruits can reduce cholesterol absorption. Nuts, seeds, avocado and unsaturated oils can replace butter and other foods high in saturated fat.

However, the word “vegetarian” describes what has been removed, not necessarily what remains. A diet dominated by refined bread, pastries, chips, cheese and sweetened foods may still be high in sodium, saturated fat and kilojoules.

Protein, iron, vitamin B12, calcium, iodine and omega-3 intake also require attention, particularly when more animal foods are excluded. A vegetarian diet works best when it is planned around nutrient-dense foods rather than meat substitutes alone.

A carefully planned vegan diet may also support healthy cholesterol and weight. However, supplementation—particularly vitamin B12—is essential, and the evidence for cardiovascular event prevention is less extensive than it is for Mediterranean eating.