The long-term effect of dietary advice in men with coronary disease: follow-up of the Diet and Reinfarction trial (DART).
OBJECTIVE
To assess the long-term effect of dietary advice on diet and mortality after a randomised trial of men with a recent history of myocardial infarction.


METHODS
Questionnaire survey and mortality follow-up after a trial of dietary advice.


METHODS
Twenty-one hospitals in south Wales and south-west England.


METHODS
Former participants in the Diet and Reinfarction Trial.


METHODS
Current fish intake and cereal fibre intake. All-cause mortality, stroke mortality and coronary mortality.


RESULTS
By February 2000, after 21147 person years of follow-up, 1083 (53%) of the men had died. Completed questionnaires were obtained from 879 (85%) of the 1030 men alive at the beginning of 1999. Relative increases in fish and fibre intake were still present at 10 y but were much smaller. The early reduction in all-cause mortality observed in those given fish advice (unadjusted hazard 0.70 (95% CI 0.54, 0.92)) was followed by an increased risk over the next 3 y (unadjusted hazard 1.31 (95% CI 1.01, 1.70). Fat and fibre advice had no clear effect on coronary or all-cause mortality. The risk of stroke death was increased in the fat advice group-the overall unadjusted hazard was 2.03 (95% CI 1.14, 3.63).


CONCLUSIONS
In this follow-up of a trial of intensive dietary advice following myocardial infarction we did not observe any substantial long-term survival benefit. Further trials of fish and fibre advice are feasible and necessary to clarify the role of these foods in coronary disease.
Ness
A R
AR
Department of Social Medicine, University of Bristol, Bristol, UK. Andy.Ness@bris.ac.uk
Hughes
J
J
Elwood
P C
PC
Whitley
E
E
Smith
G D
GD
Burr
M L
ML
D000818:Animals; D003327:Coronary Disease / Q000178:diet therapy* / Q000401:mortality; D004034:Diet Surveys; D004041:Dietary Fats / Q000008:administration & dosage*; D004043:Dietary Fiber / Q000008:administration & dosage*; D002523:Edible Grain; D005399:Fishes; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000178:diet therapy* / Q000401:mortality; D010349:Patient Compliance; D012008:Recurrence; D012307:Risk Factors; D017747:Seafood; D020521:Stroke / Q000178:diet therapy / Q000401:mortality; D011795:Surveys and Questionnaires; D016019:Survival Analysis
D004041:Dietary Fats; D004043:Dietary Fiber