Dietary patterns after myocardial infarction and future risk of major cardiovascular events, a nationwide registry study

Abstract Background Healthy dietary patterns are important for long-term cardiovascular disease prevention. However, the impact of altered dietary pattern post-myocardial infarction (MI) on major adverse cardiovascular events (MACE) is less well understood. Purpose We investigated the association between alterations in self-reported dietary patterns after MI and MACE risk. Methods Data from Swedish national registries (2016-2021) on MI patients were analyzed. Consumption of vegetables, fruit, fish and sweets during a typical week were self-reported at cardiac rehabilitation follow-up visits two-months and one-year post-MI. A "dietary score" (0-12 points) was created, with ≥9 points indicating a healthy dietary pattern. Patients were categorized into four groups based on dietary changes: consistently healthy (reference), improved, worsened and consistently unhealthy. In Cox proportional hazard regression models adjusted stepwise for age, sex, socioeconomic status, cardiovascular risk factors, physical activity and comorbidities, the future risk of MACE, expressed as hazard ratios (HR) with 95% confidence intervals (CI) by dietary pattern stratum was assessed. MACE defined as a 5-point composite measure as non-fatal myocardial infarction, non-fatal stroke, coronary revascularization, and hospitalization for newly diagnosed or worsening heart failure or cardiovascular death. Results In total, 19,910 patients (median age 65 [IQR 58-71] years, 75% men) were included. During a median follow-up of 2.21 (1.07-3.53) years 1288 MACE occurred. MACE rates per 1000 person-years were 24.2 (consistently healthy), 26.1 (improved), 27.2 (worsened) and 31.0 (consistently unhealthy) per dietary pattern group. Patients reporting a consistently healthy dietary pattern were more often female, non-smokers, married/cohabiting, more physically active, had less comorbidities, lower BMI, higher income and educational level (Table 1). Compared to patients with a consistently healthy dietary pattern, those with a consistently unhealthy dietary pattern had a higher risk of MACE after adjustments for age, sex and socioeconomic status. When adding lifestyle factors and prior diseases to the model rendered non-significant results. No significant difference in MACE risk was observed for those with improved or worsened dietary patterns (Figure 1). Conclusion Altered dietary patterns post-MI were not a strong independent predictor for future MACE and need to be assessed in the overall context of lifestyle factors and comorbidities.Figure 1  Table 1