Dietary Patterns and Risk of Major Adverse Cardiac Events

Study Questions:

Are foods common in a typical western diet associated with cardiovascular (CV) risk?


Data from the STABILITY (Stabilization of Atherosclerotic Plaque by Initiation of Darapladib Therapy) trial were used for the present analysis. Participants of the trial had stable coronary heart disease. Patients completed a lifestyle questionnaire, including questions on common foods consumed. A Mediterranean diet score was calculated for increasing consumption of whole grains, fruits, vegetables, legumes, fish, alcohol, and less meat. A Western dietary score was created for increasing consumption of refined grains, sweets and desserts, sugared drinks, and deep fried foods. The primary outcome of interest was major adverse cardiac events (MACE) defined as CV death, nonfatal myocardial infarction (MI), or nonfatal stroke.


A total of 15,482 patients (mean age 67 years) from 39 countries were included in the present analysis. Over a median follow-up of 3.7 years, MACE occurred in 2,885 (7.3%) patients who had a Mediterranean diet score ≥15. A total of 4,018 (10.5%) patients with a Mediterranean diet score of 13-14 experienced MACE and 8,579 (10.8%) patients with a Mediterranean diet score ≤12 experienced MACE. A one-unit increase in Mediterranean diet score >12 was associated with lower MACE after adjusting for all covariates (hazard ratio, 0.95; 95% confidence interval, 0.91-0.98; p = 0.002). In terms of a Western dietary score, there was no association between the score and MACE.


The investigators concluded that 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.


This secondary analysis supports prior evidence of a Mediterranean diet pattern among cardiac patients. However, the findings regarding both the Mediterranean and Western patterns are difficult to assess without understanding the relationship of foods within the two scores.

Clinical Topics: Diabetes and Cardiometabolic Disease, Prevention, Atherosclerotic Disease (CAD/PAD), Diet

Keywords: Coronary Artery Disease, Diet, Mediterranean, Food, Life Style, Mortality, Myocardial Infarction, Plaque, Atherosclerotic, Primary Prevention, Secondary Prevention, Stroke

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