The effect of dietary patterns on estimated coronary heart disease risk: results from the Dietary Approaches to Stop Hypertension (DASH) trial.
BACKGROUND
The Dietary Approaches to Stop Hypertension (DASH) diet is recommended in the 2005 US Dietary Guidelines. To understand the potential benefits of DASH on coronary heart disease (CHD), we applied the Framingham risk equations to calculate 10-year risk of developing CHD using data from the DASH trial.


RESULTS
In the DASH trial, 459 individuals with prehypertension or stage-1 hypertension not taking antihypertensive medication were randomly assigned to 1 of 3 diets: control, fruits and vegetables (F/V), or DASH (rich in fruits, vegetables, low-fat dairy, and reduced in fats and cholesterol). Weight was held constant. Estimated 10-year CHD risk was the primary outcome of this secondary analysis. Among 436 participants with complete data, mean (SD) age was 44.7 (10.7) years, 51% were male, and 60% were African-American. Median 10-year CHD risk was 0.98% at baseline and decreased in all groups. Compared with control, the relative risk ratio comparing 8-week with baseline 10-year CHD risk was 0.93 (95% confidence interval, 0.85 to 1.02; P=0.12) for F/V and 0.82 (95% confidence interval, 0.75 to 0.90; P<0.001) for DASH. Comparing DASH with F/V, the relative risk ratio was 0.89 (95% confidence interval, 0.81 to 0.97; P=0.012). With the exception of an interaction between dietary pattern and race suggesting a greater risk reduction in blacks than whites (P for interaction=0.038), results were similar across subgroups.


CONCLUSIONS
Compared with control and F/V, the DASH diet reduced estimated 10-year CHD risk by 18% and 11%, respectively. In addition to reducing blood pressure, the DASH diet should substantially reduce the risk of CHD.
Chen
Steven T
ST
Division of General Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Maruthur
Nisa M
NM
Appel
Lawrence J
LJ
D000328:Adult; D001795:Blood Pressure Determination; D003327:Coronary Disease / Q000178:diet therapy* / Q000453:epidemiology* / Q000503:physiopathology; D004035:Diet Therapy; D018752:Diet, Fat-Restricted; D005260:Female; D005638:Fruit; D006801:Humans; D006973:Hypertension; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D012306:Risk; D014481:United States; D014675:Vegetables
Am J Clin Nutr. 2001 Jul;74(1):80-9
11451721
Ann Epidemiol. 1995 Mar;5(2):108-18
7795829
JAMA. 1992 Mar 4;267(9):1213-20
1586398
JAMA. 1991 Jun 26;265(24):3255-64
2046107
N Engl J Med. 2007 Nov 22;357(21):2189-94
18032770
Arch Intern Med. 1993 Mar 8;153(5):598-615
8439223
JAMA. 2001 Jul 11;286(2):180-7
11448281
JAMA. 2005 Nov 16;294(19):2455-64
16287956
Circulation. 1998 May 12;97(18):1837-47
9603539
Circulation. 2002 Dec 17;106(25):3143-421
12485966
Arch Intern Med. 2004 Oct 25;164(19):2126-34
15505126
Arch Intern Med. 2008 Apr 14;168(7):713-20
18413553
Circulation. 2009 Apr 21;119(15):2026-31
19349322
Hypertension. 2003 Jun;41(6):1178-9
12756222
N Engl J Med. 1997 Apr 17;336(16):1117-24
9099655
Am J Health Behav. 2007 Sep-Oct;31(5):545-60
17555385