# 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

## TL;DR

Following dietary guidelines for heart disease is linked to lower long-term heart-related deaths after a heart attack.

## Contribution

A new diet quality index for CVD patients was developed and linked to mortality outcomes in a large cohort.

## Key findings

- High diet quality was associated with 22% lower CVD mortality risk compared to low diet quality.
- Each standard deviation increase in diet quality reduced CVD mortality risk by 9%.
- The benefit was stronger in patients with obesity or kidney issues.

## Abstract

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

We included 4365 MI patients of the prospective Dutch Alpha Omega Cohort (60–80 years, 80 % male). We created the Dutch Healthy Diet-Cardiovascular Disease (DHD-CVD) index, based on the 2023 Dutch dietary guidelines for CVD patients with dietary data from a validated 203-item questionnaire. Hazard Ratios (HRs) for CVD-related and all-cause mortality across quartiles of the DHD-CVD index (ref=Q1, low diet quality) and per 1-SD increment were estimated using multivariable Cox regression models. Effect modification by health determinants was examined through stratification. Numbers needed to eat (NNE) were calculated as 1 divided by the 10-year risk reduction between extreme quartiles.

The mean DHD-CVD score was 88.9 ± 14.8. During a median follow-up of 14.6 years (56,037 person-years), 2869 deaths occurred, including 1112 from CVD. High vs. low diet quality was associated with a 22 % lower risk of CVD mortality (HR:0.78, 95 %CI: 0.66, 0.93), with an HR of 0.91 (95 %CI:0.86, 0.97) per 1-SD. For all-cause mortality, HRs were 0.84 (0.76, 0.94) for high vs low and 0.93 (0.90, 0.97) per 1-SD. Associations for CVD mortality were more pronounced in patients with obesity or impaired kidney function. The NNE was 13 for CVD mortality and 77 for all-cause mortality.

Better adherence to dietary guidelines for CVD patients was associated with lower CVD and all-cause mortality risks after MI and could be an effective strategy to lower cardiovascular risk.

Graphical abstract on adherence to dietary guidelines for patients with cardiovascular disease in relation to long-term mortality.Image, graphical abstract