These 3 Dietary Habits Drive The Most Heart Disease Deaths Per Year

We all know that diet matters for heart health, but with so much conflicting advice out there, it's hard to know which changes actually move the needle.

New research cuts through the noise. A comprehensive study analyzed data from 204 countries over 33 years to identify the dietary factors that contribute most to cardiovascular disease deaths worldwide. Here are the three specific habits that caused more damage than all the others combined.

What the research found

Researchers used data from the Global Burden of Disease (GBD) 2023 study to quantify how 13 different dietary risk factors contribute to cardiovascular disease deaths and disability worldwide.

In 2023 alone, dietary risks caused nearly 6 million heart disease deaths globally. That's nearly millions of people whose deaths were linked to what they did or didn't eat.

But not all dietary factors contributed equally. Three stood out as the dominant drivers of heart disease mortality worldwide:

No. 1: High sodium intake

The study identified high sodium intake as the leading dietary risk factor for cardiovascular disease mortality and disability worldwide.

Sodium contributes to heart disease primarily through elevated blood pressure and related cardiometabolic pathways, but it's packed into the food we eat. One teaspoon of table salt contains about 2,400 mg of sodium1, and the US Department of Agriculture recommends limiting sodium intake to 2,300 milligrams per day.

The disease burden from high sodium was especially prominent in more developed regions, reflecting a widespread reliance on processed foods, restaurant foods, and high-salt cooking practices.

If you had to pick one dietary change to prioritize for heart health, reducing salt is your best bet. To reduce the sodium in your diet, take an extra second to look at food labels, minimize the amount of salt you use in home-cooking, and be mindful of the amount of sodium in your processed foods.

No. 2: Not eating enough fruit

The second-leading dietary risk factor wasn't something people were eating too much of, but rather something they weren't eating enough of.

Low fruit intake ranked as the second-largest contributor to diet-related cardiovascular disease deaths globally. In low-development regions, it was actually the top dietary risk factor, surpassing even sodium. However, high-quality fruit is expensive and hard to come by in many settings, so this may reflect food-environment constraints rather than preference alone.

Why does fruit matter so much? The researchers point to the fiber and micronutrient content of fruits, as well as their anti-inflammatory and antioxidant properties. These protective compounds may help improve cardiometabolic profiles and reduce cardiovascular risk over time.

To increase your fruit intake, aim to include it with multiple meals throughout the day. Fresh, frozen, or dried (without added sugar) all count.

No. 3: Not eating enough whole grains

Low intake of whole grains rounded out the top three dietary risk factors for cardiovascular disease mortality. And notably, this factor has increased significantly since 1990.

Like fruits, whole grains offer fiber and protective compounds that may support cardiovascular health through multiple pathways. The researchers note that higher whole-grain intake has been associated with reduced cardiovascular disease risk in prospective studies. (If you need more motivation, research shows that eating more fiber can also boost your energy levels.)

And notably, the ranking of low whole grain intake among dietary risk factors actually rose in significance since 1990, suggesting this is a growing area of concern as dietary patterns shift globally.

To increase your intake of whole grains, swap out your refined grains. This can look like choosing whole wheat bread over white, brown rice over white rice, and whole oats over refined cereals.

The silver lining in the data

Despite the rising total number of diet-related cardiovascular deaths, age-standardized rates have actually declined over the past three decades.

In 1990, the age-standardized death rate from diet-related cardiovascular disease was 119.70 per 100,000 population. By 2023, that number had dropped to 65.78 per 100,000, which marks a substantial improvement.

What explains the disconnect between rising total deaths and falling rates? Demographics. The global population has grown and aged significantly since 1990. So even though the rate of diet-related heart disease per person has improved, the sheer number of older adults means total deaths have still increased.

This means population-wide dietary improvements and cardiovascular risk management have successfully reduced the rate of diet-related cardiovascular disease per capita. The interventions are working: we just need more of them.

The takeaway

With so much dietary advice competing for your attention, it's easy to feel overwhelmed. This research offers a clear signal: if you want to reduce your cardiovascular disease risk through diet, focus on sodium, fruit, and whole grains. These three factors matter more than all the other dietary risks combined.