The Alternative Healthy Eating Index Is Associated with a Lower Risk of Fatal and Nonfatal Acute Myocardial Infarction in a Chinese Adult Population.
Indexes to quantify adherence to recommended dietary patterns have been developed for Western populations, but it is unclear whether these indexes can predict acute myocardial infarction (AMI) in Asian populations.



We aimed to investigate the association between the Alternative Healthy Eating Index (AHEI)-2010 and risk of AMI and to evaluate potential mediation by traditional cardiovascular risk factors in a Chinese population.



A nested case-control study in 751 incident cases of AMI (564 nonfatal and 288 fatal) and 1443 matched controls was conducted within the prospective Singapore Chinese Health Study, a cohort of ethnic Chinese men and women aged 45-75 y. At baseline, habitual diet was assessed by using a validated, semiquantitative food-frequency questionnaire. AMI cases were ascertained via linkage with nationwide hospital databases (confirmed through medical record review) and the Singapore Birth and Death Registry. We evaluated the association between the AHEI-2010 and cardiovascular risk factors, including glycated hemoglobin, high-sensitivity C-reactive protein, creatinine, plasma lipids (LDL and HDL cholesterol, triglycerides), and blood pressure. ORs and 95% CIs were computed by using multivariable-adjusted conditional logistic regression models.



Higher AHEI-2010 scores were associated with a lower risk of AMI (OR for the highest quartile compared with the lowest quartile: 0.62; 95% CI: 0.47, 0.81; P-trend < 0.001), with similar associations for fatal (OR: 0.60; 95% CI: 0.39, 0.94; P-trend = 0.009) and nonfatal (OR: 0.59; 95% CI: 0.43, 0.81; P-trend = 0.002) AMI. This association was only slightly attenuated after adjustment for potential biological intermediates (OR: 0.64; 95% CI: 0.48, 0.86; P-trend = 0.003).



Adherence to dietary recommendations as reflected in the AHEI-2010 was associated with a substantially lower risk of fatal and nonfatal AMI in an Asian population, and this association was largely independent of traditional cardiovascular risk factors.
Saw Swee Hock School of Public Health and.
Nithya
N
Neelakantan
Department of Pathology, Stellenbosch University, Cape Town, South Africa;
Nasheen
N
Naidoo
Saw Swee Hock School of Public Health and Duke-NUS Graduate Medical School, Singapore;
Woon-Puay
WP
Koh
Division of Cancer Control and Population Sciences, University of Pittsburgh Cancer Institute, and Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA; and.
Jian-Min
JM
Yuan
Saw Swee Hock School of Public Health and Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA rob_martinus_van_dam@nuhs.edu.sg.
Rob M
RM
van Dam
D000368:Aged; D044466:Asian People; D016022:Case-Control Studies; D015331:Cohort Studies; D004032:Diet / Q000009:adverse effects*; D000072001:Diet, Healthy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000517:prevention & control*; D016017:Odds Ratio; D011446:Prospective Studies; D012307:Risk Factors; D012846:Singapore / Q000453:epidemiology
Alternative Healthy Eating Index–2010; acute myocardial infarction; diet quality index; epidemiology; nutrition; risk factors