title: Low carbohydrate diet from plant or animal sources and mortality among myocardial infarction survivors.
abstract: BACKGROUND
  The healthiest dietary pattern for myocardial infarction (MI) survivors is not known. Specific long-term benefits of a low-carbohydrate diet (LCD) are unknown, whether from animal or vegetable sources. There is a need to examine the associations between post-MI adherence to an LCD and all-cause and cardiovascular mortality.
  
  
  RESULTS
  We included 2258 women from the Nurses' Health Study and 1840 men from the Health Professional Follow-Up Study who had survived a first MI during follow-up and provided a pre-MI and at least 1 post-MI food frequency questionnaire. Adherence to an LCD high in animal sources of protein and fat was associated with higher all-cause and cardiovascular mortality (hazard ratios of 1.33 [95% CI: 1.06 to 1.65] for all-cause mortality and 1.51 [95% CI: 1.09 to 2.07] for cardiovascular mortality comparing extreme quintiles). An increase in adherence to an animal-based LCD prospectively assessed from the pre- to post-MI period was associated with higher all-cause mortality and cardiovascular mortality (hazard ratios of 1.30 [95% CI: 1.03 to 1.65] for all-cause mortality and 1.53 [95% CI: 1.10 to 2.13] for cardiovascular mortality comparing extreme quintiles). An increase in adherence to a plant-based LCD was not associated with lower all-cause or cardiovascular mortality.
  
  
  CONCLUSIONS
  Greater adherence to an LCD high in animal sources of fat and protein was associated with higher all-cause and cardiovascular mortality post-MI. We did not find a health benefit from greater adherence to an LCD overall after MI.
authors.affiliation: Department of Epidemiology, Harvard School of Public Health, Boston, MA (S.L., A.F., F.B.H., W.C.W., E.B.R.).
authors.forename: Shanshan
authors.initials: S
authors.lastname: Li
authors.affiliation: Department of Epidemiology, Harvard School of Public Health, Boston, MA (S.L., A.F., F.B.H., W.C.W., E.B.R.) Department of Nutrition, Harvard School of Public Health, Boston, MA (A.F., F.B.H., W.C.W., E.B.R.).
authors.forename: Alan
authors.initials: A
authors.lastname: Flint
authors.affiliation: Informatics, Merck & Co, Boston, MA (J.K.P.).
authors.forename: Jennifer K
authors.initials: JK
authors.lastname: Pai
authors.affiliation: Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (J.P.F., F.B.H., W.C.W., E.B.R.).
authors.forename: John P
authors.initials: JP
authors.lastname: Forman
authors.affiliation: Department of Epidemiology, Harvard School of Public Health, Boston, MA (S.L., A.F., F.B.H., W.C.W., E.B.R.) Department of Nutrition, Harvard School of Public Health, Boston, MA (A.F., F.B.H., W.C.W., E.B.R.) Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (J.P.F., F.B.H., W.C.W., E.B.R.).
authors.forename: Frank B
authors.initials: FB
authors.lastname: Hu
authors.affiliation: Department of Epidemiology, Harvard School of Public Health, Boston, MA (S.L., A.F., F.B.H., W.C.W., E.B.R.) Department of Nutrition, Harvard School of Public Health, Boston, MA (A.F., F.B.H., W.C.W., E.B.R.) Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (J.P.F., F.B.H., W.C.W., E.B.R.).
authors.forename: Walter C
authors.initials: WC
authors.lastname: Willett
authors.affiliation: Division of Preventive Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (K.M.R.).
authors.forename: Kathryn M
authors.initials: KM
authors.lastname: Rexrode
authors.affiliation: Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Brookline, MA (K.J.M.).
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Mukamal
authors.affiliation: Department of Epidemiology, Harvard School of Public Health, Boston, MA (S.L., A.F., F.B.H., W.C.W., E.B.R.) Department of Nutrition, Harvard School of Public Health, Boston, MA (A.F., F.B.H., W.C.W., E.B.R.) Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (J.P.F., F.B.H., W.C.W., E.B.R.).
authors.forename: Eric B
authors.initials: EB
authors.lastname: Rimm
mesh_terms: D000328:Adult; D000818:Animals; D002318:Cardiovascular Diseases / Q000178:diet therapy / Q000401:mortality / Q000517:prevention & control; D002423:Cause of Death; D015331:Cohort Studies; D050528:Diet, Carbohydrate-Restricted; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000401:mortality* / Q000517:prevention & control / Q000628:therapy; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D055502:Secondary Prevention / Q000379:methods*; D016019:Survival Analysis; D017741:Survivors; D013997:Time Factors; D016896:Treatment Outcome
keywords: low‐carbohydrate diet; mortality; myocardial infarction; secondary prevention