How We Ranked These
Heart disease is the single condition where our rubric and veterinary cardiology consensus diverge most — and cardiology wins. The FDA’s investigation into diet-associated dilated cardiomyopathy (DCM) in non-predisposed breeds has identified grain-free, legume-heavy, boutique, or exotic-protein diets (collectively “BEG diets”) as statistically associated with DCM incidence. Veterinary cardiologists now routinely recommend grain-inclusive food from makers that meet WSAVA’s guidelines for cardiac patients.
We filtered for three criteria: (1) grain-inclusive formulations — specifically avoiding the legume-heavy grain-free formulas flagged in the FDA investigation; (2) ingredient sourcing, nutritionist oversight, and AAFCO feeding-trial validation; (3) established cardiac-nutrition research track record.
Our Top 5 Picks
1. Purina Pro Plan Sport 30/20 — B (76/100)
Purina Pro Plan Sport comes from a maker that meets WSAVA’s guidelines. The 30% protein / 20% fat profile supports lean muscle maintenance — important because cardiac dogs often develop cardiac cachexia (muscle wasting despite normal body weight), which is an independent predictor of poor prognosis. Salmon-based recipes add EPA/DHA omega-3s.
Pro Plan Sport is also grain-inclusive — corn gluten meal, rice, and whole grain corn — which addresses the FDA DCM concern head-on. Nestlé Purina employs more board-certified veterinary nutritionists (DACVIMs) than any other pet food company and runs AAFCO feeding trials on every formula. Read our full Purina Pro Plan Sport review → · Shop on Amazon →
2. Purina Pro Plan Sensitive Skin & Stomach — B (79/100)
For cardiac dogs with concurrent GI sensitivity or skin issues (common in older dogs with multi-system disease), Pro Plan Sensitive uses salmon as the primary protein — inherently high in EPA/DHA — and combines it with rice and oat meal for digestible grain-inclusive carbohydrates. Feeding trials, nutritionist oversight, and the same Purina research infrastructure apply. Protein at 28% is appropriate for cardiac patients; fat is moderate, sodium is controlled.
This is the more widely available Purina cardiac-appropriate option — retail availability at grocery and pet chains beats premium brands when a CHF dog needs consistent food access and no supply gaps. Read our full Purina Pro Plan Sensitive review → · Shop on Amazon →
3. Hill’s Science Diet — B (76/100)
Hill’s employs board-certified veterinary nutritionists, runs AAFCO feeding trials, and has the longest cardiac-nutrition research track record of any manufacturer (dating to the original Hill’s h/d heart diet in the 1950s).
For dogs in early CHF or with mitral valve disease where a prescription diet isn’t yet warranted but a base food from a maker that meets WSAVA’s guidelines is recommended, Science Diet is the default. If your cardiologist names a specific brand, this is often what they mean. Read our full Hill’s Science Diet review → · Shop on Amazon →
4. Iams ProActive Health — C (58/100)
Iams is another maker that meets WSAVA’s guidelines, with a long research track record. Chicken-first grain-inclusive formulas, added taurine in many recipes (taurine deficiency is directly implicated in DCM risk for Cocker Spaniels, Newfoundlands, Goldens, and in cats across the board), controlled fat, and mainstream retail availability make Iams a practical default for cost-sensitive cardiac feeding. Mars Petcare (Iams’ parent) runs the Waltham Petcare Science Institute, one of the two major commercial pet-nutrition research programs.
Not a premium ingredient profile, but veterinary cardiologists rarely object to Iams for cardiac patients — the research backing carries more weight than the rubric score. Read our full Iams review → · Shop on Amazon →
5. Eukanuba — B (76/100)
Eukanuba, like Iams, is a Mars Petcare brand backed by the Waltham Petcare Science Institute. Chicken-first grain-inclusive formulas, added L-carnitine in several performance and senior recipes, and feeding-trial validated. L-carnitine supplementation is directly relevant to cardiac disease — it supports cardiac muscle energy metabolism and is a specific adjunctive therapy in DCM.
Eukanuba is particularly suitable for senior cardiac dogs who need a grain-inclusive, high-palatability food with muscle-maintenance support. Not the cleanest ingredient profile on the rubric, but cardiologist-approved. Read our full Eukanuba review → · Shop on Amazon →
What to Look for in a Food for Heart Disease
Grain-inclusive, from a maker that meets WSAVA’s guidelines, and feeding-trial validated. These three criteria do the bulk of the work. The FDA’s June 2019 update on BEG-diet DCM named specific grain-free brands.
Taurine and cardiac-amino-acid adequacy. Taurine deficiency is directly cardiotoxic — dogs with low plasma or whole-blood taurine develop DCM. Certain breeds are genetically predisposed to taurine deficiency regardless of diet: Cocker Spaniels, Golden Retrievers, Newfoundlands, Saint Bernards, Portuguese Water Dogs. For these breeds, look for foods with added taurine listed on the ingredient panel (many Purina and Iams recipes include it). For other breeds, taurine synthesis from methionine and cysteine is usually adequate provided protein quality is high.
Sodium control in stage B2+ CHF. Mitral valve disease progression divides into stages A (at risk), B1 (asymptomatic, small heart), B2 (asymptomatic, enlarged heart), C (symptomatic CHF), and D (refractory CHF). Sodium restriction matters starting at stage B2: target <0.3% dry matter sodium, with more aggressive restriction (<0.2% DMB) for stage C–D dogs. Prescription cardiac diets hit these targets; commercial foods vary — request a technical data sheet from the manufacturer to confirm.
EPA/DHA omega-3 fatty acids. Some foods include fish oil; others require supplementation (your veterinarian sets the dose). Coenzyme Q10, L-carnitine, and taurine supplementation are adjunctive interventions your cardiologist may layer on top of diet.
Avoid boutique, exotic, and grain-free (BEG) diets for cardiac patients. This is the single most important rule from the FDA DCM investigation. Kangaroo, alligator, buffalo, duck-and-pea, lamb-and-lentil, and similar boutique or exotic-protein grain-free foods have been statistically associated with DCM in breeds not genetically predisposed. If you’ve been feeding a BEG diet and your dog has been diagnosed with DCM, transition to a grain-inclusive food from a maker that meets WSAVA’s guidelines.
Honorable Mention
For diagnosed stage B2+ mitral valve disease or dilated cardiomyopathy (DCM), Hill’s Prescription Diet h/d Heart Care and Royal Canin Early Cardiac are the veterinary therapeutic cardiac diets. Both feature aggressive sodium restriction, added taurine and L-carnitine, increased EPA/DHA, and are evidence-backed for cardiac patients. Neither is in our database, but they’re the first-line option your cardiologist will recommend for symptomatic heart disease. Veterinary prescription required.
Bottom Line
For heart disease, the right food is the one your veterinary cardiologist recommends — Purina Pro Plan Sensitive (B/79) is our highest-scoring pick, but Purina Pro Plan Sport, Hill’s Science Diet, Iams, and Eukanuba all meet the WSAVA + grain-inclusive + feeding-trial criteria. If you’re feeding a boutique, exotic-protein, or grain-free diet and your dog has been diagnosed with DCM or CHF, change foods and ask your cardiologist about echo rechecks at 3–6 months.
Corrected 2026-10-19: we removed medication or supplement doses (your veterinarian sets doses), study and guideline citations we could not verify, and claims we could not support; we corrected factual errors, and grades and score comparisons that did not match our current scores.