[Advancing cardiovascular prevention : Evidence-based design of healthy and sustainable food environments]

Malnutrition is among the leading modifiable risk factors for cardiovascular diseases worldwide. Current international guidelines consistently recommend predominantly plant-based dietary patterns rich in vegetables, fruits, whole grains, legumes and unsaturated fats. At the same time, the diet affects not only individual health but also the ecological foundations of future health. The nutrition system substantially contributes to greenhouse gas emissions, biodiversity loss, land-use change and freshwater consumption. This article argues that nutrition should therefore be understood as a dual lever for prevention: both for reducing cardiovascular disease and for stabilizing health-relevant ecological systems. While evidence supporting the cardiovascular benefits of high-quality plant-based diets continues to grow, implementation at the population level remains insufficient. The article discusses the limited long-term effectiveness of purely educational and individual responsibility-focused approaches and contrasts these with the more consistent evidence supporting structural interventions. In particular, fiscal policies, restrictions on unhealthy food marketing, healthy food standards in public institutions and modifications of food environments have demonstrated robust effects on dietary behavior and health outcomes. Against this background an expansion of cardiovascular prevention towards the active shaping of healthy and sustainable food environments is proposed. Physicians and medical societies could play a substantially stronger role in advocating evidence-based structural prevention policies.