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July 3, 2025Socio-Environmental Systems ModelingOpen Access

Adherence to dietary guidelines is associated with a lower risk of long-term cardiovascular mortality after myocardial infarction: a prospective analysis in the Alpha Omega Cohort

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Key result

High dietary guideline adherence is linked to ~22% lower CV mortality post-MI.

  • HR 0.78
  • 95% CI 0.66, 0.93
  • NNT 13
  • n=4,365

Why the study?

Dietary guidelines specifically for patients with atherosclerotic cardiovascular disease were investigated in relation to long-term mortality after myocardial infarction.

Does high adherence to dietary guidelines reduce long-term cardiovascular and all-cause mortality in patients after myocardial infarction?

Population

4365 MI patients aged 60-80 years, 80% male, from the Dutch Alpha Omega Cohort

Comparison

High vs low adherence to the 2023 Dutch dietary guidelines for CVD patients (highest vs lowest quartile of DHD-CVD index)

Design

Prospective cohort study

Follow-up

Median 14.6 years

Authors

ECEsther CruijsenWageningen University & ResearchIDIris van DammeWageningen University & ResearchAWAnniek C. van WestingWageningen University & Research

Discussion

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Implication

Higher DHD-CVD adherence was associated with lower post-MI mortality; extends prior observational data but leaves causal benefit open for trials.

Study Design

Type

Cohort (n=4,365)

Multicenter

Yes

Structured PICO

Does high adherence to dietary guidelines reduce long-term cardiovascular and all-cause mortality in patients after myocardial infarction?

P
Population
4,365 Dutch patients aged 60-80 years with a history of myocardial infarction, followed for a median of 14.6 years.
E
Exposure
High adherence to the 2023 Dutch dietary guidelines for CVD patients (highest quartile of the Dutch Healthy Diet-Cardiovascular Disease [DHD-CVD] index).
C
Comparator
Low adherence to the dietary guidelines (lowest quartile [Q1] of the DHD-CVD index).
O
Outcome
Cardiovascular disease (CVD)-related mortality and all-cause mortality.hard clinical

Main Result

Hazard Ratio: 0.78 (95% CI 0.66–0.93)

Absolute Risk Reduction: 8%

Number Needed to Treat: 13

Better adherence to dietary guidelines for CVD patients is associated with significantly lower long-term cardiovascular and all-cause mortality after myocardial infarction.

Limitations

  • Dietary assessment was conducted only at baseline, without repeated measurements, potentially leading to misclassification.
  • Salt intake was not accurately captured by the food frequency questionnaire as it did not cover discretionary salt use.
  • Adjustment for total energy intake limits the ability to study the impact of overconsumption and excessive calorie intake.

Cite This Study

Cruijsen et al. (2025) conducted a cohort in Myocardial infarction (n=4,365). Adherence to dietary guidelines for CVD patients (DHD-CVD index) vs. Low adherence to dietary guidelines (Quartile 1) was evaluated on Cardiovascular mortality (HR 0.78, 95% CI 0.66, 0.93). High adherence to dietary guidelines for cardiovascular disease patients was associated with a 22% lower risk of cardiovascular mortality (HR 0.78) compared to low adherence in post-myocardial infarction patients.

synapsesocial.com/papers/6ab340978f706e25623b170dhttps://doi.org/10.1016/j.ajpc.2025.101056
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Also Consider

Synapse has enriched 4 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Cardiovascular mortality attributable to dietary risk factors in 54 countries in the WHO European Region from 1990 to 2019: an updated systematic analysis of the Global Burden of Disease Study2024 · 32 citations
  2. 22023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines2023 · 1,564 citations
  3. 3Effect of anti-inflammatory diets on inflammation markers in adult human populations: a systematic review of randomized controlled trials2022 · 60 citations
  4. 4Relationship Between Healthy Diet and Risk of Cardiovascular Disease Among Patients on Drug Therapies for Secondary Prevention2012 · 185 citations