Healthy eating and lower mortality risk in a large cohort of cardiac patients who received state-of-the-art drug treatment.
BACKGROUND
Little is known about dietary scores and mortality risk in cardiac patients who are well treated with drugs with attendant relatively low risk of cardiovascular diseases (CVDs).


OBJECTIVE
We assessed whether healthy eating lowers the risk of CVD and all-cause mortality in cardiac patients.


METHODS
We included 4307 patients from the Alpha Omega Trial aged 60-80 y with a clinically diagnosed myocardial infarction and monitored mortality for 10 y. Diet was assessed at baseline (2002-2006) with a validated 203-item food-frequency questionnaire. We created 2 dietary scores on the basis of nonoverlapping sets of foods: the Dutch Healthy Nutrient and Food Score (DHNaFS) and the Dutch Undesirable Nutrient and Food Score (DUNaFS). The associations of both dietary scores with CVD and all-cause mortality were assessed by using multivariable-adjusted Cox regression models.


RESULTS
The median time after myocardial infarction at baseline was 3.7 y (IQR: 1.7-6.3 y). During a median of 6.5 y of follow-up (IQR: 5.3-7.6 y), 801 patients died; 342 of those died of CVD. One patient was lost to follow-up. A substantially higher average amount of DHNaFS foods (∼1750 g/d) than DUNaFS foods (∼650 g/d) was consumed. Almost all patients received drug treatment: 86% used statins, 90% used antihypertensive medication, and 98% used antithrombotic medication. Patients in the fifth quintile of the DHNaFS had a 30% (HR: 0.70; 95% CI: 0.55, 0.91) lower CVD risk and a 32% (HR: 0.68; 95% CI: 0.47, 0.99) lower all-cause mortality risk than did patients in the first quintile. The DUNaFS was unrelated to both CVD and all-cause mortality.


CONCLUSIONS
Beyond state-of-the-art drug treatment, healthy eating was associated with a lower risk of CVD and all-cause mortality in cardiac patients. This trial was registered at clinicaltrials.gov as NCT00127452.
Division of Human Nutrition, Wageningen University, Wageningen, Netherlands;
Femke P C
FP
Sijtsma
Division of Human Nutrition, Wageningen University, Wageningen, Netherlands; sabita.soedamah-muthu@wur.nl.
Sabita S
SS
Soedamah-Muthu
Division of Human Nutrition, Wageningen University, Wageningen, Netherlands;
Janette
J
de Goede
Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom;
Linda M
LM
Oude Griep
Division of Human Nutrition, Wageningen University, Wageningen, Netherlands;
Johanna M
JM
Geleijnse
Department of Psychiatry, Leiden University Medical Center, Leiden, Netherlands;
Erik J
EJ
Giltay
Department of Cardiology, Radboud University Medical Center Nijmegen, Nijmegen, Netherlands;
Menko Jan
MJ
de Boer
Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN; and Department of Nutrition, University of Oslo, Oslo, Norway.
David R
DR
Jacobs
Division of Human Nutrition, Wageningen University, Wageningen, Netherlands;
Daan
D
Kromhout
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D000959:Antihypertensive Agents / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000178:diet therapy / Q000188:drug therapy / Q000453:epidemiology / Q000401:mortality; D015331:Cohort Studies; D003131:Combined Modality Therapy; D004311:Double-Blind Method; D058620:Elder Nutritional Physiological Phenomena; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D005500:Follow-Up Studies; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D009026:Mortality; D009203:Myocardial Infarction / Q000401:mortality / Q000517:prevention & control; D009426:Netherlands / Q000453:epidemiology; D018673:Nutrition Policy; D010349:Patient Compliance; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D016032:Randomized Controlled Trials as Topic
D000959:Antihypertensive Agents; D005343:Fibrinolytic Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
cardiac patients; cardiovascular disease; epidemiology; food-based dietary scores; mortality