Cardiovascular disease, which includes coronary heart disease and stroke, is the leading cause of death in the United States. However, cardiovascular disease can be largely prevented by a healthy lifestyle including a healthy diet.
The American Heart Association/American College of Cardiology recommends a heart-healthy diet limited to 5% to 6% of calories from saturated fatty acid and underscores the replacement of saturated fatty acid and trans-fat with monounsaturated fats and polyunsaturated fats, for the prevention of cardiovascular disease.
Avocados are a nutrient-dense fruit, containing dietary fiber, potassium, magnesium, monounsaturated fats, and polyunsaturated fatty acids, as well as phytonutrients and bioactive compounds, which have been independently associated with cardiovascular health.
The most commonly consumed variety in the United States, Hass avocado, contains 13 g of oleic acid in a medium-sized fruit (136 g), comparable to the amount of oleic acid in 1.5oz (42 g) of almonds or 2 tablespoons (26 g) of olive oil.
Specifically, half an avocado provides up to 20% of the daily recommended fiber, 10% of potassium, 5% of magnesium, and 15% of folate, as well as 7.5 g of monounsaturated fats and 1.5 g of polyunsaturated fatty acid.
As such, avocados can be a nutrient-dense component of a healthful dietary pattern.
National population data have indicated that after accounting for lifestyle and sociodemographic factors including socioeconomic status, avocado consumers tend to have higher high-density lipoprotein cholesterol levels; a lower risk of metabolic syndrome; and lower weight, body mass index, and waist circumference, compared with avocado nonconsumers.
Although avocado-induced changes in the cardiovascular disease risk profile of individuals have been investigated, clinical trials are limited to intermediate risk factors as end points.
“Our study provides further evidence that the intake of plant-sourced unsaturated fats can improve diet quality and is an important component in cardiovascular disease prevention,” said Dr. Lorena Pacheco, a postdoctoral researcher at the Harvard T.H. Chan School of Public Health.
“These are particularly notable findings since the consumption of avocados has risen steeply in the U.S. in the last 20 years, according to data from the U.S. Department of Agriculture.”
The study included 68,786 women from the NHS (Nurses’ Health Study) and 41,701 men from the HPFS (Health Professionals Follow-up Study; 1986-2016) who were free of cancer, coronary heart disease, and stroke at baseline.
The researchers documented 9,185 coronary heart disease events and 5,290 strokes during more than 30 years of follow-up.
They assessed participants’ diet using food frequency questionnaires given at the beginning of the study and then every four years.
They calculated avocado intake from a questionnaire item that asked about the amount consumed and frequency. One serving equaled half of an avocado or a half cup of avocado.
After considering a wide range of cardiovascular risk factors and overall diet, the participants who ate at least two servings of avocado each week had a 16% lower risk of cardiovascular disease and a 21% lower risk of coronary heart disease, compared to those who never or rarely ate avocados.
Based on statistical modeling, replacing half a serving daily of margarine, butter, egg, yogurt, cheese or processed meats such as bacon with the same amount of avocado was associated with a 16% to 22% lower risk of cardiovascular disease events.
Substituting half a serving a day of avocado for the equivalent amount of olive oil, nuts and other plant oils showed no additional benefit.
No significant associations were noted in relation to stroke risk and how much avocado was eaten.
“Offering the suggestion to replace certain spreads and saturated fat-containing foods, such as cheese and processed meats, with avocado is something physicians and other health care practitioners such as registered dietitians can do when they meet with patients, especially since avocado is a well-accepted food,” Dr. Pacheco said.
The findings were published in the Journal of the American Heart Association.
Lorena S. Pacheco et al. Avocado Consumption and Risk of Cardiovascular Disease in US Adults. Journal of the American Heart Association, published online March 30, 2022; doi: 10.1161/JAHA.121.024014