During 30 months of follow-up, a total of 1,391 events occurred, of which 1,262 were cardiovascular events and 140 were limb events. The researchers analysed the association between diet quality and adverse events after adjusting for factors that could influence the relationship including age, sex, country, education level, treatments and medications, body mass index, smoking, and other conditions such as diabetes, high blood pressure, and heart failure.
The results of this study suggest that patients with CAD and PAD should prioritise consuming whole foods and minimising packaged and processed foods to reduce the likelihood of having a heart attack or stroke. The study found that a higher quality diet was associated with a lower risk of cardiovascular and limb events. Patients with the worst quality diet had a 27% higher likelihood of vascular complications compared to those with the best quality diet, even after adjusting for factors that might affect the association.
The study also found that a modified Mediterranean diet score was not statistically significant in reducing the risk of cardiovascular and limb events. However, the results trended towards this benefit, suggesting that a more comprehensive dietary questionnaire that includes all the foods that characterise a Mediterranean diet should be used in future studies.
INCREASED PLANT-BASED INTAKE
The authors of the study conclude that dietary recommendations should shift the emphasis to improving overall dietary quality rather than specific food types. Recommendations should include greater consumption of fruits, vegetables, nuts, higher fiber foods, choosing white over red meat, and consumption of minimally processed foods. This shift in emphasis may improve the applicability to a larger general population with a variety of cultural backgrounds and simplify advice to patients.
Even after adjusting for factors that might affect the association, patients with the worst quality diet had a 27% higher likelihood of vascular complications compared to those with the best quality diet. This excess in risk seems to be mainly due to a higher rate of heart attacks, strokes and cardiovascular deaths regardless of whether patients had heart disease or blockages in the arteries outside of the heart.
Conclusion: Dietary interventions that promote a higher quality diet emphasising whole foods and minimising processed foods and red meat may have important implications for patients with cardiovascular disease. This study suggests that patients with CAD and PAD should consider making dietary changes to reduce their risk of vascular complications.