Dairy Intake and Risk for CVD Events and Mortality

Sep 12, 2018
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Authors:
Dehghan M, Mente A, Rangarajan S, et al.
Citation:
Association of Dairy Intake With Cardiovascular Disease and Mortality in 21 Countries From Five Continents (PURE): A Prospective Cohort Study. Lancet 2018;Sep 11:[Epub ahead of print].
Summary By:
Elizabeth A. Jackson, MD, FACC

Study Questions:

Is diary consumption associated with risk for mortality and major cardiovascular (CV) events?

Methods:

Data from the PURE (Prospective Urban Rural Epidemiology) study were used for the present study. PURE is a large multiinternational cohort study of adults 35-79 years of age enrolled from 21 countries across five continents. Dietary intakes of dairy products for 136,384 individuals (free of CV disease [CVD] at baseline) were recorded using country-specific validated food frequency questionnaires. Dairy products comprised milk, yogurt, and cheese. Dairy foods were further grouped into whole-fat and low-fat dairy. The primary outcome of interest was a composite of events comprised of all-cause mortality, CVD-caused mortality, nonfatal myocardial infarction, stroke, or heart failure, assessed between January 1, 2003, and July 14, 2018.

Results:

A total of 136,384 adults were included in this analysis. Over the 9.1 years of follow-up, 10,567 composite events were recorded, including 6,796 deaths and 5,855 major CV events. Higher intake of total dairy (>2 servings per day compared with no intake) was associated with a lower risk of the composite outcome (hazard ratio [HR], 0.84; 95% confidence interval [CI], 0.75-0.94; p trend = 0.0004). Total mortality (HR, 0.83; 95% CI, 0.72-0.96; p trend = 0.0052), non-CV mortality (HR, 0.86; 95% CI, 0.72-1.02; p trend = 0.046), CV mortality (HR, 0.77; 95% CI, 0.58-1.01; p trend = 0.029), major CVD (HR, 0.78; 95% CI, 0.67-0.90; p trend = 0.0001), and stroke (HR, 0.66; 95% CI, 0.53-0.82; p trend = 0.0003) were also lower among those who had ≥2 servings of dairy compared to those with no dairy consumption. No significant association between diary intake and myocardial infarction was observed. Higher intake of dairy, defined as >1 serving versus no intake of milk (HR, 0.90; 95% CI, 0.82-0.99; p trend = 0.0529) and yogurt (HR, 0.86; 95% CI, 0.75-0.99; p trend = 0.0051), was associated with lower risk of the composite outcome. While cheese intake was not significantly associated with the composite outcome, butter intake was low and was not significantly associated with the clinical outcomes. Among those who consumed only whole-fat diary, higher intake of total dairy was associated with lower risk for the composite outcome, total mortality and major CVD.

Conclusions:

The authors concluded that dairy consumption was associated with lower risk of mortality and major CVD events in a diverse multinational cohort.

Perspective:

These data suggest that diary is associated with lower risk for all-cause mortality and CVD events even after adjustment for physical activity, caloric intake, smoking, and other potential confounders. Although residual confounding may be present, the authors present strong evidence from there for diary consumption as part of a healthy diet.

Keywords: Butter, Cardiovascular Diseases, Cheese, Dairy Products, Diet, Diet, Fat-Restricted, Energy Intake, Heart Failure, Milk, Myocardial Infarction, Primary Prevention, Stroke, Vascular Diseases, Yogurt


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