Dietary patterns predict heart attack risk in middle-aged men

In a large-scale study of middle-aged men spanning eight years, Hu and colleagues tracked the food consumption of 44,875 men and identified two overall dietary patterns which they labeled as either "prudent" or "Western." The subjects were all health professionals aged 40-75 having no symptoms of CVD at the beginning of the study in 1986. Cases of nonfatal myocardial infarction and fatal coronary heart disease in the study population were tracked over the entire eight years and correlated to food consumption data. The research, published in The American Journal of Clinical Nutrition, showed that the prudent diet significantly reduces the risk of developing cardiovascular disease(CVD), whereas the Western diet significantly increases CVD risk. The prudent pattern has a higher intake of vegetables, fruit, legumes, whole grains, fish and poultry. In contrast, the Western pattern has a higher intakes of red meat, processed meat, refined grains, sweets and desserts, French fries and high-fat dairy products. Men who adhered to the prudent dietary pattern had one-third the relative risk of cardiovascular disease of those who stuck most closely to the Western pattern. In addition, the Western pattern was often associated with other risk factors such as smoking or family history of CVD.

A range of important differences in lifestyle factors and relative risk of CVD emerged between the two dietary groups. Participants who were in quintile 5 of the prudent pattern score were more likely to take multivitamin and vitamin E supplements and to engage in exercise, less likely to smoke cigarettes, and were slightly older and leaner. In contrast, men with the highest quintile (5) Western pattern score were more likely to smoke and drink alcohol and less likely to take a multivitamin or vitamin E supplements. Current smokers in quintile 5 of the Western pattern had more than three times the risk for CVD than current smokers in quintile 5 of the prudent pattern. In subjects who had a family history of CVD, those in quintile 5 of the Western pattern were almost three times more at risk for CVD than those in quintile 5 of the prudent pattern. In all cases, CVD risks other than diet such as smoking, family history or overweight had more of a negative impact on subjects who followed a Western diet pattern than on those who followed a prudent pattern.

The study raises an ancillary interest in recent ecological observations connecting diet with rates of cardiovascular disease worldwide. The authors state that, "The Mediterranean and Asian diets have attracted considerable interest as alternatives to the Western diet because of the extremely low rates of CHD in Greece and Japan." These diets include increased consumption of whole grains, legumes, vegetables, fruit (Mediterranean countries) and fish. The considerable overlap among these two types of heart-healthy diets and the prudent diet pattern observed by the authors contributes to confidence in the prudent pattern as a sound regimen for the prevention of CVD. The authors maintain that an approach toward disease prevention which looks at overall dietary patterns rather than specific nutrients more closely parallels the situation in the real world, where dietary intakes consist of nutrients that occur together in common foods.

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Hu, F B, et al. Prospective study of major dietary patterns of risk of coronary heart disease in men. Am J Clin Nut 72;2000:912-21.

For more information please contact: Dr. F. B. Hu at frank.hu@channing.harvard.edu

This media release is provided by The American Society for Clinical Nutrition, to provide current information on nutrition-related research. This information should not be construed as medical advice. If you have a medical concern, consult your doctor.

To see the complete text of this article, please go to: http://www.faseb.org/ascn/temp/ajcn/October/912-921-11292-hu.pdf

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