Pills Aren't Enough: Why Your Diet Matters Even More Than Heart Medications

Even if you're taking heart medications, eating fewer ultra-processed foods and foods high in sodium, sugar, and saturated fat provides additional cardiovascular protection that pills alone cannot deliver. A new study of over 2,100 Canadian adults found that reducing ultra-processed food intake by just 10% was linked to a 13% lower risk of heart disease, regardless of whether participants were taking blood pressure or cholesterol-lowering medications.

Can Medications Alone Protect Your Heart?

For decades, doctors have relied on medications to manage cardiovascular risk factors like high blood pressure and high cholesterol. But a groundbreaking analysis published in The American Journal of Clinical Nutrition reveals an important truth: medications work best when paired with dietary improvements, not as replacements for them. Researchers from the CARTaGENE cohort study in Quebec, Canada, tracked nearly 2,100 adults aged 40 to 69 years with diagnosed hypertension or high cholesterol over an average of 9.3 years. During that time, 179 cardiovascular events—including heart attacks, strokes, and cardiovascular deaths—occurred among the group.

The critical finding: participants taking cardioprotective medications who also reduced their intake of foods of concern still experienced additional heart protection compared to those relying on medications alone. This suggests that diet and drugs operate through different mechanisms, making them complementary rather than interchangeable.

What Exactly Are "Foods of Concern"?

The study defined foods of concern in two ways. First, researchers used the Nova classification system to identify ultra-processed foods—products that undergo extensive industrial processing and typically contain added sugars, unhealthy fats, and sodium. Second, they applied Canada's front-of-package nutrition warning labels, which flag foods high in saturated fat, sodium, or added sugars.

The scope of the problem is striking: among study participants who were already aware of their cardiovascular risk, ultra-processed foods made up 41% of their daily diet by weight, while foods carrying warning labels accounted for 38% of their total caloric intake. This reveals how deeply these problematic foods are embedded in modern eating patterns, even among people actively managing heart health.

How Much Diet Change Actually Matters?

The study used a substitution-based approach, meaning that reducing foods of concern automatically increases intake of other, healthier options. Here's what the numbers showed:

• Ultra-Processed Foods: A 10% reduction in ultra-processed food intake (measured by weight) was associated with approximately a 13% lower hazard of cardiovascular disease.
• Warning-Label Foods: A similar 10% reduction in foods bearing front-of-package warning symbols showed comparable cardiovascular risk reduction.
• Nutrient Improvements: Participants with lower intake of foods of concern also consumed fewer total calories and had lower intakes of saturated fat and sodium, supporting the link between overall dietary quality and heart health.

Importantly, both approaches to identifying problematic foods—processing level and nutrient warning labels—showed similar protective associations, even though they don't identify identical food categories. This consistency strengthens confidence in the findings.

Do Medications Reduce the Benefits of Eating Better?

This is where the study's most practical insight emerges. Researchers specifically tested whether taking blood pressure-lowering or cholesterol-lowering medications weakened the protective effect of eating fewer foods of concern. The answer was a clear no.

"No evidence was found that medication use attenuated the protective association between lower consumption of foods of concern and cardiovascular disease risk," the researchers noted. In other words, if you're already on heart medications, improving your diet doesn't become less important—it becomes even more valuable because the benefits stack on top of each other. Participants taking cardioprotective medications continued to experience additional cardiovascular benefits from reducing ultra-processed foods and foods high in sodium, added sugars, and saturated fat.

This finding challenges a common misconception: that once you're on medication, dietary changes matter less. The evidence suggests the opposite. Medications and dietary improvements act independently, meaning you get the protective effects of both when you combine them.

What Should You Actually Do With This Information?

The practical takeaway is straightforward but powerful: if you have high blood pressure or high cholesterol, don't view your medications as a license to ignore what you eat. Instead, think of them as a foundation that works best when paired with dietary improvements.

The study focused on middle-aged adults in Quebec, so results may not apply equally to all populations. Additionally, like all observational research, it cannot prove that diet directly causes the risk reduction—only that the association exists. However, the consistency of findings across multiple analytical approaches and subgroups strengthens confidence in the results.

For individuals, clinicians, and policymakers, the research underscores a fundamental principle: comprehensive cardiovascular disease prevention requires combining dietary improvement with pharmacological management. Neither approach alone is sufficient. Your medications are important, but what you put on your plate matters just as much.