Exploring high protein diets in the context of cardiac rehabilitation

Abstract

The review aims to explore the potential benefit and risk of high protein diets (HPDs) regarding the comorbidity of sarcopenia and cardiovascular disease (CVD) in the setting of cardiac rehabilitation (CR). CR is standard care for individuals who have experienced a cardiac event, but the current practice of predominantly aerobic exercise, a lower-fat diet, and weight loss poorly addresses the issue of sarcopenia. HPDs, especially when combined with resistance exercise (RE), may be valuable adjuncts to current CR practice and benefit both muscle and cardiovascular health. Meta-analyses and randomised controlled trials of HPDs and CVD risk show beneficial but variable effects regarding weight loss, the lipid profile, insulin resistance, and lean body mass in those living with or high risk of CVD. Meta-analyses of prospective cohort studies on hard CVD endpoints favour lower and plant protein diets over higher animal protein, but the evidence is inconsistent. HPDs augment the strength and muscle gaining benefits of RE in older populations, but there are no published data in those living with CVD providing promising opportunities for CR research. HPDs raise concern regarding renal and bone health, the microbiome, branched chain amino acids, and environmental sustainability and findings suggest that plant-based HPDs may confer ecological and overall health advantages compared to animal-based HPDs. However, incorporating resistance exercise with HPDs might alleviate certain health risks. In conclusion, a largely plant-based HPD is deemed favourable for CR when combined with RE, but further research regarding efficacy and safety in CR populations is needed.