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Food, inflammation and cardiovascular diseases

Scientific evidence on diet and health is gradually becoming known. The multiple causes of many diseases in the health sciences and the different types of influence of risk or preventative factors make it difficult to reach clear conclusions. In the field of nutrition, research is even more complex because humans are omnivorous and our diet is not always the same, as it changes with age and throughout the year. We often have to wait many years from the collection of exposure information to the onset of the disease.

In order to receive more solid information, this informative work focuses on research reviews and meta-analyses. In this type of work, all articles published with established parameters and minimum quality criteria (published in indexed journals) are analyzed. In this way, inconsistent (time-varying) one-off information is reduced.

In a previous article (Aurrekoetxea, 2021), I analyzed the influence of fat consumption on cardiovascular diseases, trying to overcome previous assumptions, promoted by the doctors themselves and, originally, by the most prestigious researchers of the link between cardiovascular diseases and food. This article aims to bring the reader closer to the scientific evidence on the influence of food, in favor or against inflammation, and its influence on cardiovascular diseases.

Cardiovascular diseases

Cardiovascular diseases form a heterogeneous group of problems that affect the heart and blood vessels. Among them, atherosclerosis (arteriosclerosis) is the most important. These diseases are characterized by inflammation, oxidative stress, cell proliferation, hypertrophy and abnormal remodeling of the heart or blood vessels. Atherosclerosis has serious consequences, including coronary heart disease, ischemic heart disease, myocardial infarction, heart failure, stroke, heart attack, peripheral arterial disease, and hypertension. Current statistics indicate that more than 500 million people worldwide are affected by cardiovascular disease; 20.5 million people died of cardiovascular disease in 2021, which represents almost a third of the world’s total mortality rate (Jiang, 2025).

Inflammation

Inflammation is a response of the immune system to tissue damage caused by infection, injury, or irritation. It is the body’s natural reaction to protect itself and repair the damage. Inflammation refers to the immune response of the body to inflammatory agents or cell injury. Chronic low-level inflammation is associated with the onset and acceleration of age-related diseases and an increased risk of various non-communicable diseases. The World Health Organization has identified non-communicable diseases as a major threat to health and sustainability. The global incidence of chronic diseases associated with inflammation, such as cardiovascular disease, type 2 diabetes mellitus, and some specific cancers, will increase over the next three decades. with the aim of reducing premature mortality by 30% by 2030 through the prevention and treatment of non-communicable diseases, interest in the relationship between diet and disease has increased (Reineke, 2025).

Chronic inflammation influences the pathogenesis of atherosclerosis through vascular endothelial damage, oxidative stress and thrombosis. Chronic tissue damage leads to the release of pro-inflammatory cytokines. This results in continuous systemic inflammation, which can have a significant impact on the development of cardiovascular diseases. Studies have indicated that certain inflammatory proteins may be associated with the risk of cardiovascular disease. In this sense, the CDC of the United States (Centers for Disease Control and Prevention) and a consortium of specialists of the American Heart Association have indicated that high sensitivity C-reactive protein (PCR-sh) is the most reliable clinical analysis to assess the risk of cardiovascular diseases and establish prognosis (Jiang, 2025).

The diet

Diet can affect the risk of chronic diseases through various mechanisms of action (e.g., modulation of gut microbiome, oxidative stress, and energy balance). For these mechanisms of action, the possible anti-inflammatory properties of dietary patterns and their individual components are important. Healthy dietary patterns are associated with a reduction in pro-inflammatory markers. For example, the Mediterranean diet, rich in fruits, vegetables, blue fish, birds, extra virgin olive oil and whole grains, is associated with a reduction in systemic inflammatory markers CRP. Intervention studies indicate a causal relationship: a meta-analysis that investigated the effect of the Mediterranean diet showed significant reductions in CRP and interleukin-6 (cytokine), as well as an increase in adiponectin (hormone with anti-inflammatory effect). In addition, certain compounds found in nutrient-rich foods, such as omega-3 fatty acids, fiber and polyphenols, have been shown to have anti-inflammatory properties. However, the so-called Western diet, especially the US diet (low consumption of fruits and vegetables and high consumption of ultra-processed foods, high caloric content), is associated with higher levels of inflammatory markers (Marx, 2021). Unfortunately, this dietary model is gradually replacing the traditional European diet.

Dietary indices

The inflammatory potential of dietary patterns can be assessed by the Dietary Index of Inflammation (HID). This tool quantifies the effect of diet on body inflammation through a balance between pro- and anti-inflammatory dietary components. A large number of indices have been created on the diet. A review of these by Reineke and lag (2025) addressed the association between dietary indices and chronic inflammation biomarkers and examined the association between dietary index and multiple inflammatory biomarkers or inflammatory biomarkers. And the most commonly used biomarker to assess inflammation has been PCR or PCR-sh.

The dietary indices analyzed classified fruits and vegetables as systematically beneficial, obtaining higher scores with greater consumption, with some exceptions, such as tomatoes and potatoes, whose classification was not highlighted. More than half of the indices classified the legumes as beneficial dietary ingredients. In almost all the indices, cereals, especially whole grains, appeared as beneficial dietary ingredients and were positively valued with greater consumption.

In general, fish/seafood was considered beneficial because eating more was better rated; on the other hand, eating more red or processed meat was consistently considered harmful. Most of the indices considered dairy products as a food group, but the classification of this component was not in favor or against. Although low-fat dairy products were considered very beneficial, they were halfway between whole or unspecified dairy products. Olive oil and vegetable oils stood out strongly for their better qualification. However, animal fats generally received adverse ratings. Saturated fats, added sugars and sugary drinks were considered harmful or pro-inflammatory. Alcohol consumption was also considered more harmful than healthy.

Red and processed meats, animal fats, alcohol, refined cereals and added sugars are associated with increased biomarkers of inflammation and are detrimental to health. Ed: Couleur/Pixabay and Matthias Böckel/Pixabay respectively.

In summary, this review showed that dietary patterns based on vegetable, low-fat, proteinaceous, and unsaturated fats are associated with lower inflammation and lower risk of cardiovascular disease, morbidity, and mortality. On the other hand, diets rich in red and processed meats, fat-rich dairy products, refined cereals, added sugars and animal fats are associated with an increase in pro-inflammatory biomarkers and are detrimental to health. In addition, diets rich in red and processed meats, fat-rich dairy products, refined cereals, added sugars and animal fats are associated with an increase in pro-inflammatory biomarkers and therefore health damage (Reineke et al., J. Am 2025).

Dietary models

Several dietary anti-inflammatory models have been investigated, such as the Mediterranean, Nordic, DASH (Dietary Approaches to Stop Hypertension), ketogenic or vegan diet. The Mediterranean diet represents a high consumption of extra virgin olive oil, blue fish and vegetable foods rich in polyphenols (fruits, vegetables and whole grains). The DASH diet highlights a decrease in sodium (< 2,300 mg/day) combined with high-potassium foods (fruits, vegetables, whole grains, nuts and seeds) and low-fat dairy products. The Nordic diet is based on ingredients of local origin, including berries, cruciferous vegetables and rapeseed oil. The vegan diet is based on proteins from legumes and flax seeds to optimize omega-3/6 ratios. The ketogenic diet works according to another metabolic paradigm and is based on a drastic reduction of carbohydrates and high fat consumption (70-80% of calories).

A meta-analysis (Jiang, 2025) added the following terms to its search strategy: on the one hand, dietary index of inflammation, anti-inflammatory diet, dietary score, Mediterranean diet, DASH diet, vegan diet, Nordic diet, ketogenic diet, vegetarian diet or plant-based diet, and on the other hand, coronary disease, ischemic heart disease, myocardial infarction, stroke, heart attack and hypertension.

The intervention of the study was an anti-inflammatory dietary model that could include the Mediterranean diet, DASH, Nordic, ketogenic or vegetarian. At the same time, the intervention could focus on the dietary approach, emphasizing a combination of foods characterized by a balanced nutritional profile. This profile resulted in increased consumption of anti-inflammatory foods such as fresh fruits and vegetables, whole grains, legumes, fish, nuts and natural spices. The moderate consumption of high-sugar, high-salt and high-fat inflammatory foods was also considered. In contrast, the control group followed an omnivorous diet with pro-inflammatory characteristics.

This meta-analysis examined the effects of the anti-inflammatory diet on triglycerides, HDL-cholesterol and LDL-cholesterol and general cholesterol. No significant correlation was identified between the anti-inflammatory diet group and HDL cholesterol levels. The anti-inflammatory diet group significantly reduced LDL cholesterol. In addition, overall cholesterol levels were also significantly lower in the anti-inflammatory diet group. Dietary anti-inflammatory intervention also significantly reduced PCR-sh compared to the control group (Jiang, 2025).

A systematic review (Marx, 2021) collected and synthesized the results of meta-analyses of observational studies. These studies examined the association between HID and any available health conditions. he addressed HID based on 45 dietary parameters in foods (e.g., omega-3 fatty acids), compounds (e.g., flavonoids), and foods (e.g., garlic, ginger) identified in the literature with anti-inflammatory or anti-inflammatory properties. HID was validated in 29 studies with various inflammatory markers such as PCR, interleukin-6 and tumor necrosis factor alpha (TNF-α, another pro-inflammatory cytokine). In the results, the diseases associated with inflammation were (from greater to lesser, but significantly) myocardial infarction, cancer in general, and some specific ones (rectum, pancreas, mouth, respiratory system), and all kinds of mortality.

As Marx (2021) points out, many bioactive compounds may be responsible for associations between their review diet and health outcomes. Examples of dietary ingredients that are added to HID and have been shown to have anti-inflammatory properties include phytochemicals such as polyphenols, omega-3 fatty acids, and dietary fiber. Increased dietary intake of polyphenols has been associated with a decrease in pro-inflammatory markers due to their antioxidant properties. Many omega-3 fatty acids have also been found to have anti-inflammatory potential. The effect of dietary ingredients, both anti-inflammatory and favorable, seems to act through the gut microbiome. However, dietary components common in the Western dietary pattern, such as trans and saturated fatty acids, can increase inflammation (Marx, 2021).

In short, it is increasingly evident that cardiovascular diseases (or atherosclerosis), the first cause of death in the world, are caused by inflammations in the tissues of the body. Inflammation can cause many chronic diseases of the body in addition to atherosclerosis, such as type II diabetes, cancer, and other diseases (digestive, rheumatological, etc.).

The diet has been associated with atherosclerosis and other diseases such as cancer. Both groups of diseases show a high concordance with both beneficial and harmful foods. Oxidative stress, excessive production of free radicals and the inability of our body to neutralize them can trigger an inflammatory response. Similarly, inflammation can produce more free radicals and thus exacerbate the problem. The current diet is increasingly rich in highly refined carbohydrates. These cause high blood glucose peaks and, as a result, high insulin concentrations, thereby activating inflammation and oxidative stress in tissues.

There is still much to investigate about the entire causal tree of atherosclerosis. There are many risk factors associated with this disease (genetics or heredity, hypertension, diabetes, smoking, obesity, sedentary lifestyle, air pollution and diet, to name but a few), and the mechanism of action of each of them has not yet been solved.

The microbiome has recently created great hope because of the role it could play in many chronic diseases. The association between Imidazole propionate (ImP) and other microbiota dependent metabolites and GKB and other diseases was known. A new publication (Mastrangelo, 2025) provides a new approach to the problem by verifying that, on the one hand, ImP was associated with the progression of atherosclerosis in mice and with active subclinical atherosclerosis in a cohort of healthy workers, and on the other hand, atherosclerosis was detected by advanced imaging tools. In addition, ImP was found to cause atherosclerosis without affecting the blood cholesterol concentration. This reinforces the belief that lipoproteins (cholesterol) could play a secondary role in the causal chain of cardiovascular diseases, with inflammation being the main protagonist. Cholesterol, from this new approach to inflammation, could be a consequence of the attack on the arteries and would therefore be an indirect, not causal, indicator of the arterial attack, since inflammation would be the main causative effect.

Bibliography

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Mastrangelo A and friends. [Imidazole propionate is a driver and therapeutic target in atherosclerosis]. Nature 2025 Jul 16.

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Schwingshackl L, Hoffmann G. [Mediterranean dietary pattern, inflammation and endothelial function: a systematic review and meta-analysis of intervention trials]. Nutr Metab Cardiovasc Dis 2014;24(9):929–39.

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