Many healthy diets tie to lower heart risk after cancer, but not low-carb

Clinical takeaway: Hold off on low-carb plans, which showed no lower risk, as a cardiovascular strategy for cancer survivors. Point them toward any of several healthy patterns such as DASH. 

Clinicians counseling cancer survivors on diet work from general-population guidance aimed at preventing chronic disease and cancer recurrence. No guideline names an eating pattern for survivors specifically, even as the US is expected to count 26 million of them by 2040 and cardiovascular disease stands as the leading cause of death among them outside of cancer. 

Evidence tying individual patterns to cardiovascular outcomes in this group has come mostly from studies of one pattern or one cancer type. This prospective cohort analysis extends the question to common healthy eating patterns across survivors of many cancers, and tests which of them is associated with fewer cardiovascular events. 

Seven of the eight patterns tracked with lower cardiovascular risk among survivors who followed them most closely, with low-carb as the sole exception. Survivors in the top fifth of adherence to the Alternate Healthy Eating Index-2010 (AHEI-2010), a score that rewards vegetables, fruit, whole grains, and omega-3 fats while limiting processed meat and trans fats, had 37% lower risk than those in the bottom fifth, and the Dietary Approaches to Stop Hypertension (DASH) diet followed at 35% lower. The healthful plant-based diet index showed the smallest gap at 18% lower. 

Low-carb adherence tied to 11% lower risk, a difference the confidence interval could not separate from none. The risk curve also bent upward at the highest low-carb scores, so more adherence did not mean less risk. 

AHEI-2010 tracked with fewer ischemic heart disease events, heart failure cases, and strokes. DASH did so for ischemic heart disease and heart failure but not stroke. The Mediterranean-DASH Intervention for Neurodegenerative Delay diet had the lowest all-cause mortality risk, 33% below the bottom fifth. At age 45, survivors in the top fifth of adherence were estimated to live 1.7 to 3.3 years longer than those in the bottom fifth, depending on the pattern. 

Investigators drew on 8,716 cancer survivors in the UK Biobank who were free of heart disease and stroke at baseline and had completed between one and five 24-hour dietary recalls. About four in 10 completed only one. Diet scores averaged all recalls each survivor completed. A sensitivity analysis limited to survivors with two or more recalls gave consistent results. Over a median follow-up of 12.3 years, 1,116 survivors developed ischemic heart disease, heart failure, or stroke. 

Randomized trials of dietary interventions in survivors would test whether these patterns lower cardiovascular events. The authors call for them, with attention to when diet changes should start relative to the end of cancer treatment. 

“Our findings suggest that the cardiovascular benefits of diet in cancer survivors are not confined to one ‘ideal’ diet but are observed across several evidence-based healthy dietary patterns, supporting a flexible rather than prescriptive nutritional approach in cancer survivorship care,” the authors wrote. 

Source: Gao QY, et al. (2026 Oct 29) JACC Adv. Healthy dietary patterns and incident cardiovascular disease in cancer survivors: a prospective cohort study