Twenty years ago, doctors advised us to use margarine, eat pasta, and avoid chocolate; now we know that margarine hides dangerous fats, refined pasta causes inflammation, and chocolate actually is good for you. So what's the truth about heart-healthy eating?

Big news: Fat isn't the main issue. "For cardiovascular health, there is little evidence that total fat intake strongly influences risk, and reducing saturated fat intake isn't even in the top five" dietary habits for heart health, says Dariush Mozaffarian, MD, DrPH, a cardiologist at Harvard Medical School. It's more important to avoid trans fats and to emphasize healthy fats, such as those in olive oil and nuts, he says.

Meanwhile, it's time to toss the white pasta and pastries for good. "One of the most important new findings is that a high intake of refined starches and sugars substantially increases the risk of heart disease," says Walter Willett, MD, DrPH, of the Harvard School of Public Health. "These foods depress beneficial HDL cholesterol and raise triglyceride levels and inflammatory factors." New studies show that inflammation plays a crucial role in all stages of the development of heart disease (Arteriosclerosis, Thrombosis, and Vascular Biology, 2006, vol. 26, no. 5).

The optimal heart-healthy diet emphasizes fish, fruits, vegetables, olive oil, and nuts, all washed down with green tea and topped off with?hooray!?dark chocolate. Here's the latest pulse on hearty eating.

  • Fish. Several current studies confirm (again) that omega-3 fatty acids, the healthy fats in fish such as salmon and mackerel, decrease all types of cardiovascular disease risk and can reduce the risk of death from coronary artery disease by as much as 50 percent (American Journal of Cardiology, 2006, vol. 98, no. 4A). For the greatest effect, eat fatty fish at least twice a week.
  • Fruits and vegetables. Increasing daily fruit and vegetable intake to a mere five servings could reduce heart disease and stroke incidence by up to 24 percent (Public Health Nutrition, 2006, vol. 9, no. 5). How? Plant foods' antioxidants prevent cholesterol oxidation in arteries; vitamin C reduces inflammation; and fiber helps flush cholesterol. New research also suggests that high nitrate content in fruits and veggies converts into heart-protective compounds (Nitric Oxide, 2006, vol. 15, no. 4).
  • Nuts. Remember when these were forbidden food? Now research suggests that people who eat nuts five or more times a week lower their heart disease risk?a protective effect attributed mainly to nuts' excellent omega-3 fatty acids. Best choices include walnuts, almonds, pecans, pistachios, and macadamia nuts.
  • Olive oil. In new research, people who ate a Mediterranean diet rich in olive oil showed a significant reduction in blood glucose levels, blood pressure, and cholesterol, compared with people who followed a low-fat diet (Annals of Internal Medicine, 2006, vol. 145, no. 1). Long known to increase HDL and lower LDL cholesterol, olive oil now appears to reduce levels of C-reactive protein, an inflammation marker (Canadian Journal of Physiology and Pharmacology, 2006, vol. 84, no. 2).
  • Green tea. Coffee lovers, rethink your brew; green tea appears to help the heart by inhibiting cholesterol synthesis and the development of atherosclerosis (Vascular Pharmacology, 2006, vol. 44, no. 6). Just two to four cups daily can help your heart.
  • Chocolate. We've saved the best for last: Chocolate does, indeed, appear to have potent heart-protective effects. New reviews suggest that cocoa lowers blood pressure, reduces inflammation, increases HDL, and decreases LDL oxidation (Nutrition and Metabolism [London], 2006, vol. 3). Choose extra-dark chocolate for the highest antioxidant content, and eat it moderately?about an ounce a day is plenty.

Lisa Turner, a nutrition and food writer, eats chocolate at every possible opportunity.