Effect of diet on outcomes in patients with stable coronary heart disease

The authors studied whether a ‘Mediterranean’ or ‘Western’ dietary pattern could predict outcomes in high-risk patients with stable coronary heart disease. Authors concluded that eating healthier foods may be more important than avoiding less healthy foods typical of Western diets.

The traditional Mediterranean diet includes a large number of healthy foods, such as fruit, vegetables, legumes, whole grains, fish, moderate alcohol, and little meat. A Mediterranean dietary pattern has been associated with reduced death rate. The American Heart Association recommends frequent consumption of fruit, vegetables, fish, and other whole foods. Few large international studies have evaluated the relationship between dietary pattern and outcomes in patients with stable coronary heart disease. 

15,828 patients with coronary heart disease from 39 countries were studied. They received darapladib, a drug that reduces levels of fat in the body. Based on a questionnaire, patients were scored for Mediterranean diet and Western Diet. A higher score indicates increased consumption of that diet. The occurrence of major adverse cardiovascular events was examined over an average of 3.7 years. Cardiovascular events included death from heart-related causes and non-fatal heart attack or stroke. 

Overall, a major adverse cardiovascular event occurred in 10.1% of patients. A major adverse cardiovascular event occurred in 7.3% of patients with a Mediterranean diet scores (MDS) of 15 or more. This was significantly lower compared to 10.5% of patients with an MDS of 13 to 14 and 10.8% of patients with an MDS of 12 or less.

For MDS of 12 or less, there was no significant association between increase in MDS and major adverse cardiovascular event. For MDS more than 12, an increase in MDS was associated with a lower risk of a major adverse cardiovascular event. There was no association between higher Western diet scores and major adverse cardiovascular event.

The authors concluded that a diet containing more food groups included in the traditional Mediterranean diet was associated with a lower risk of major cardiovascular adverse event and death from any cause. 

Diet scores were based off a questionnaire that participants answered themselves.