Dietary patterns and the risk of major adverse cardiovascular events in a global study of high-risk patients with stable coronary heart disease.
To determine whether dietary pattern assessed by a simple self-administered food frequency questionnaire is associated with major adverse cardiovascular events (MACE) in high-risk patients with stable coronary artery disease.



A Mediterranean dietary pattern has been associated with lower cardiovascular (CV) mortality. It is less certain whether foods common in western diets are associated with CV risk.



At baseline, 15 482 (97.8%) patients (mean age 67 ± 9 years) with stable coronary heart disease from 39 countries who participated in the Stabilisation of atherosclerotic plaque by initiation of darapladib therapy (STABILITY) trial completed a life style questionnaire which included questions on common foods. A Mediterranean diet score (MDS) was calculated for increasing consumption of whole grains, fruits, vegetables, legumes, fish, and alcohol, and for less meat, and a 'Western diet score' (WDS) for increasing consumption of refined grains, sweets and deserts, sugared drinks, and deep fried foods. A multi-variable Cox proportional hazards models assessed associations between MDS or WDS and MACE, defined as CV death, non-fatal myocardial infarction, or non-fatal stroke.



After a median follow-up of 3.7 years MACE occurred in 7.3% of 2885 subjects with an MDS ≥15, 10.5% of 4018 subjects with an MDS of 13-14, and 10.8% of 8579 subjects with an MDS ≤12. A one unit increase in MDS >12 was associated with lower MACE after adjusting for all covariates (+1 category HR 0.95, 95% CI 0.91, 0.98, P = 0.002). There was no association between WDS (adjusted model +1 category HR 0.99, 95% CI 0.97, 1.01) and MACE.



Greater consumption of healthy foods may be more important for secondary prevention of coronary artery disease than avoidance of less healthy foods typical of Western diets.
Green Lane Cardiovascular Service, Auckland City Hospital, University of Auckland, Private Bag 92024, Auckland 1030, New Zealand rstewart@adhb.govt.nz.
Ralph A H
RA
Stewart
Department of Medical Sciences, Cardiology, Uppsala Clinical Research Center (UCR), Uppsala University, Uppsala, Sweden.
Lars
L
Wallentin
Green Lane Cardiovascular Service, Auckland City Hospital, University of Auckland, Private Bag 92024, Auckland 1030, New Zealand.
Jocelyne
J
Benatar
Hôpital Européen Georges Pompidou, Assistance Publique Hôpitaux de Paris, INSERM U-970, Université Paris Descartes, Paris, France.
Nicolas
N
Danchin
Department of Medical Sciences, Cardiology, Uppsala Clinical Research Center (UCR), Uppsala University, Uppsala, Sweden.
Emil
E
Hagström
Department of Medical Sciences, Cardiology, Uppsala Clinical Research Center (UCR), Uppsala University, Uppsala, Sweden.
Claes
C
Held
Medical Department, Hospital Unit West, Herning/Holstebro, Denmark.
Steen
S
Husted
Department of Medicine and Population Health Research Institute, McMaster University, Hamilton, ON, Canada.
Eva
E
Lonn
Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA.
Amanda
A
Stebbins
Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA.
Karen
K
Chiswell
Department of Medical Sciences, Cardiology, Uppsala Clinical Research Center (UCR), Uppsala University, Uppsala, Sweden.
Ola
O
Vedin
Metabolic Pathways and Cardiovascular Therapeutic Area, GlaxoSmithKline, Research Triangle Park, NC, USA.
David
D
Watson
Green Lane Cardiovascular Service, Auckland City Hospital, University of Auckland, Private Bag 92024, Auckland 1030, New Zealand.
Harvey D
HD
White
D000368:Aged; D003327:Coronary Disease; D038441:Diet, Mediterranean; D006801:Humans; D009203:Myocardial Infarction; D016016:Proportional Hazards Models; D012307:Risk Factors
Cardiovascular prevention; Coronary artery disease; Mediterranean diet; Mortality