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Dietary Patterns and Mediterranean Diet Score and Hazard of Recurrent Coronary Heart Disease Events and All-Cause
James M Shikany1, Monika M Safford2, Joanna Bryan2
1Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, AL jshikany@uabmc.edu.
Insights
Adhering to the Mediterranean diet may lower the risk of recurrent coronary heart disease (CHD) events and all-cause mortality. Conversely, the Southern dietary pattern is linked to increased mortality risk in individuals with existing CHD.
Area of Science:
- Cardiovascular Disease Epidemiology
- Nutritional Science
- Public Health
Background:
- Previous research in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study explored dietary patterns and incident coronary heart disease (CHD).
- This study focuses on participants with pre-existing CHD to examine dietary impacts on recurrent events and mortality.
Purpose of the Study:
- To investigate the association between dietary patterns and a dietary index with recurrent CHD events.
- To examine the association between dietary patterns and a dietary index with all-cause mortality in individuals with established CHD.
Main Methods:
- Utilized data from 3562 REGARDS participants with existing CHD.
- Employed Cox proportional hazards regression to analyze associations between dietary patterns (convenience, plant-based, sweets, Southern, alcohol and salads) and the Mediterranean diet score with recurrent CHD events and all-cause mortality.
- Follow-up occurred over a median of 7.1 years.
Main Results:
- Higher adherence to the Mediterranean diet score was associated with a reduced hazard of recurrent CHD events (HR, 0.78; 95% CI, 0.62-0.98).
- The Southern dietary pattern showed an adverse association with all-cause mortality (HR for Q4 vs. Q1, 1.57; 95% CI, 1.28-1.91).
- Greater adherence to the Mediterranean diet score was also linked to a lower hazard of all-cause mortality (HR, 0.80; 95% CI, 0.67-0.95).
Conclusions:
- The Southern dietary pattern is associated with an increased risk of all-cause mortality among individuals with existing CHD.
- Adherence to the Mediterranean diet is associated with a decreased risk of both recurrent CHD events and all-cause mortality in this population.
Background:
Previously, we reported on associations between dietary patterns and incident acute coronary heart disease (CHD) in the REGARDS (Reasons for Geographic and Racial Differences in Stroke) study. Here, we investigated the associations of dietary patterns and a dietary index with recurrent CHD events and all-cause mortality in REGARDS participants with existing CHD.
Methods And Results:
We included data from 3562 participants with existing CHD in REGARDS. We used Cox proportional hazards regression to examine the hazard of first recurrence of CHD events-definite or probable MI or acute CHD death-and all-cause mortality associated with quartiles of empirically derived dietary patterns (convenience, plant-based, sweets, Southern, and alcohol and salads) and the Mediterranean diet score. Over a median 7.1 years (interquartile range, 4.4, 8.9 years) follow-up, there were 581 recurrent CHD events and 1098 deaths. In multivariable-adjusted models, the Mediterranean diet score was inversely associated with the hazard of recurrent CHD events (hazard ratio for highest score versus lowest score, 0.78; 95% confidence interval, 0.62-0.98; PTrend=0.036). The Southern dietary pattern was adversely associated with the hazard of all-cause mortality (hazard ratio for Q4 versus Q1, 1.57; 95% confidence interval, 1.28-1.91; PTrend<0.001). The Mediterranean diet score was inversely associated with the hazard of all-cause mortality (hazard ratio for highest score versus lowest score, 0.80; 95% confidence interval, 0.67-0.95; PTrend=0.014).
Conclusions:
The Southern dietary pattern was associated with a greater hazard of all-cause mortality in REGARDS participants. Greater adherence to the Mediterranean diet was associated with both a lower hazard of recurrent CHD events and all-cause mortality.
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