How We Ranked These
Every food on this list was scored using KibbleIQ’s ingredient analysis rubric, which evaluates protein quality, filler content, preservative safety, and overall ingredient transparency on a 0–100 scale. Heart disease is the single condition where our rubric and veterinary cardiology consensus diverge most — and cardiology wins. The FDA’s ongoing 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 WSAVA-compliant manufacturers 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) compliance with WSAVA Global Nutrition Committee guidelines for ingredient sourcing, nutritionist oversight, and AAFCO feeding-trial validation; (3) established cardiac-nutrition research track record. Only five major manufacturers meet all three: Purina, Hill’s, Royal Canin, Eukanuba, and Iams.
Our Top 5 Picks
1. Purina Pro Plan Sport 30/20 — B (76/100)
Purina Pro Plan Sport is one of the highest-scoring WSAVA-compliant commercial foods and the strongest cardiac-appropriate pick on our catalog. 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, which ACVIM guidelines endorse for anti-arrhythmic effect in DCM and CHF patients.
Pro Plan Sport is also grain-inclusive — brewers rice, corn gluten meal, and oat meal — 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 (76/100)
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 — C (61/100)
Hill’s Science Diet scores lower than Purina Pro Plan on our ingredient rubric because of its heavier use of by-product meals and corn-based carbohydrate sources, but it’s one of the five WSAVA-compliant brands veterinary cardiologists most often recommend. 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 WSAVA-compliant base food 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 (63/100)
Iams is another WSAVA-compliant brand 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 and WSAVA compliance carry more weight than the rubric score. Read our full Iams review → · Shop on Amazon →
5. Eukanuba — C (60/100)
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 (Cornell 50–200 mg/kg/day research protocols).
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, WSAVA-compliant, feeding-trial validated. These three criteria do the bulk of the work. The FDA’s July 2019 update on BEG-diet DCM named specific grain-free brands associated with elevated DCM incidence; subsequent research (Freeman et al., JAVMA 2020; Kaplan et al., PLOS ONE 2018) reinforced the grain-inclusive guidance for cardiac patients. Only five manufacturers currently meet the full WSAVA GNC recommendations: Purina, Hill’s, Royal Canin, Eukanuba, Iams. Veterinary cardiologists overwhelmingly recommend from this list.
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. The American College of Veterinary Internal Medicine (ACVIM) Consensus Statement on mitral valve disease divides disease progression 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 reduce arrhythmia. Fish oil supplementation (target 40 mg/kg EPA + 25 mg/kg DHA per day, per Freeman et al.) reduces arrhythmia burden and improves cachexia in cardiac dogs. Some WSAVA-compliant foods — Pro Plan Sport, Pro Plan Sensitive — include clinically meaningful fish-oil doses; others require supplementation. 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 WSAVA-compliant grain-inclusive food — echocardiographic improvement has been documented in a subset of DCM dogs after the diet change alone (Freeman 2020).
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 commercial review catalog, 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 from the five WSAVA-compliant manufacturers — Purina Pro Plan Sport and Purina Pro Plan Sensitive are our highest-ingredient-scoring picks within that set, but Hill’s Science Diet, Iams, and Eukanuba all meet the WSAVA + grain-inclusive + feeding-trial criteria that cardiac medicine currently endorses. 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 to document the diet-response benefit that research has consistently shown.