What does this research mean for the field?

Myocardial infarction survivors who consume a higher-quality diet, or improve their diet quality after their MI, experience significantly lower all-cause and cardiovascular mortality. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

September 2, 2013Open Access

Better Diet Quality and Decreased Mortality Among Myocardial Infarction Survivors

Structured PICO

Does higher post-MI dietary quality reduce all-cause and cardiovascular mortality in myocardial infarction survivors?

Population

4,098 adults (2,258 women from the Nurses' Health Study and 1,840 men from the Health Professionals Follow-up Study) in the United States who survived an initial myocardial infarction and completed pre- and post-MI food frequency questionnaires.

Intervention

Higher post-MI dietary quality (measured by Alternative Healthy Eating Index 2010 [AHEI2010]) and greater increase in AHEI2010 score from pre- to post-MI.

Comparator

Lower post-MI dietary quality (comparing extreme quintiles of AHEI2010).

Outcome

All-cause mortality and cardiovascular mortality.hard clinical

Higher diet quality and improvements in diet quality after a myocardial infarction are associated with significantly lower all-cause mortality.

Abstract

IMPORTANCE: Information about diet after myocardial infarction (MI) and mortality is limited, despite the growing number of MI survivors in the United States. OBJECTIVE: To examine the association of post-MI dietary quality and changes from pre- to post-MI with all-cause and cardiovascular mortality among MI survivors. DESIGN, SETTING, AND PARTICIPANTS: We included 2258 women from the Nurses' Health Study and 1840 men from the Health Professionals Follow-up Study. Participants had survived an initial MI during the study follow-up period and completed the pre- and post-MI food frequency questionnaire. Diet quality was measured using Alternative Healthy Eating Index 2010 (AHEI2010), which consists of food and nutrients associated with the risk of chronic disease reported in the literature. We adjusted for medication use, medical history, and lifestyle risk factors using Cox proportional hazards regression models. MAIN OUTCOMES AND MEASURES: All-cause and cardiovascular mortality. RESULTS: During follow-up, we confirmed 682 all-cause deaths for women and 451 for men. The median survival time after the initial MI onset was 8.7 years for women and 9.0 years for men. When the results were pooled, the adjusted hazard ratio (HR) was 0.76 (95% CI, 0.60-0.96) for all-cause mortality and 0.73 (95% CI, 0.51-1.04) for cardiovascular mortality, comparing the extreme quintiles of post-MI AHEI2010. A greater increase in the AHEI2010 score from pre- to post-MI was significantly associated with lower all-cause mortality (pooled HR, 0.71; 95% CI, 0.56-0.91) and cardiovascular mortality (pooled HR, 0.60; 95% CI, 0.41- 0.86), comparing the extreme quintiles. The adjusted HRs associated with post-MI AHEI2010 were 0.73 (95% CI, 0.58-0.93) for all-cause mortality and 0.81 (95% CI, 0.64-1.04) for cardiovascular mortality when the alcohol component was excluded. CONCLUSIONS AND RELEVANCE: Myocardial infarction survivors who consume a higher-quality diet, which has been associated with a lower risk of coronary heart disease in primary prevention, have lower subsequent all-cause mortality.

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