Better Diet Quality and Decreased Mortality Among Myocardial Infarction Survivors

Study Questions:

Is a healthy dietary pattern after myocardial infarction (MI) associated with all-cause and cardiovascular mortality among MI survivors?


Data from the Nurses’ Health Study and the Health Professionals Follow-up Study were used for this analysis. 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. Adjustment was made for medication use, medical history, and lifestyle risk factors. The primary outcomes of interest were all-cause and cardiovascular mortality.


A total of 2,258 women and 1,840 men were included. During follow-up, 682 all-cause deaths and 336 cardiovascular deaths occurred in the women, and 451 all-cause deaths and 222 cardiovascular deaths occurred in the men. The median survival time after the initial MI onset was 8.7 years for women and 9.0 years for men. Participants on average improved diet quality from pre- to post-MI, with a greater increase of the AHEI2010 score in men (median change, 5.5) compared with women (median change, 2.1). For both men and women, the greatest improvement of diet quality from pre- to post-MI was an increase in whole grain intake and a reduction in consumption of trans fat and red and processed meat. The lowest score for a diet component in the post-MI period was sugar-sweetened beverage consumption. When the results were pooled, the adjusted hazard ratio (HR) was 0.76 (95% confidence interval [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.


The investigators concluded that MI survivors who consume a higher-quality diet have lower subsequent all-cause mortality.


A healthy dietary pattern has been associated with reduction in risk of heart events among adults who have no prior history of cardiac disease. These data support the benefits of a healthy dietary pattern after MI. Clinicians should encourage all patients including those with established heart disease to adopt a healthy diet, high in whole grains, fruits, and vegetables, and low in saturated and trans fats.

Clinical Topics: Dyslipidemia, Prevention, Lipid Metabolism, Diet

Keywords: Myocardial Infarction, Life Style, Follow-Up Studies, Chronic Disease, Food Habits, Risk Factors, Trans Fatty Acids, Heart Diseases, Cause of Death, Cardiology, Sweetening Agents, Cardiovascular Diseases, Confidence Intervals, Diet

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