April 26, 2026European Heart Journal127 citationsOpen Access
View Full PaperDietary patterns and the risk of major adverse cardiovascular events in a global study of high-risk patients with stable coronary heart disease
Key Result
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.
Key Points
- To examine the relationship between dietary patterns and major adverse cardiovascular events (MACE) in patients with stable coronary artery disease.
- Analyzed data from 15,482 high-risk patients with stable coronary heart disease across 39 countries.
- Used a self-administered food frequency questionnaire to calculate Mediterranean diet scores (MDS) and Western diet scores (WDS).
- Employed multi-variable Cox proportional hazards models to assess the associations between dietary scores and MACE.
- After 3.7 years, MACE occurred in 7.3% of 2885 patients with MDS ≥15, compared to 10.8% in those with MDS ≤12.
- A one unit increase in MDS >12 was linked to lower MACE (HR 0.95, 95% CI 0.91, 0.98, P=0.002).
- No significant link was found between WDS and MACE (HR 0.99, 95% CI 0.97, 1.01).
Structured PICO
Does greater consumption of healthy foods reduce major adverse cardiovascular events in high-risk patients with stable coronary heart disease?
P
Population
High-risk patients with stable coronary heart disease
I
Intervention
Greater consumption of healthy foods
C
Comparator
Avoidance of less healthy foods typical of Western diets
O
Outcome
Major adverse cardiovascular eventshard clinical
Emphasizing the consumption of healthy foods may be a more effective dietary strategy for secondary prevention in stable CAD than merely avoiding Western diet components.
Main Result
Absolute Event Rate: 0% vs 0%
Abstract
OBJECTIVES: 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. BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.