Healthy eating and lower mortality risk in a large cohort of cardiac patients who received state-of-the-art drug treatment

Am J Clin Nutr. 2015 Dec;102(6):1527-33. doi: 10.3945/ajcn.115.112276. Epub 2015 Oct 21.


Background: Little is known about dietary scores and mortality risk in cardiac patients who are well treated with drugs with attendant relatively low risk of cardiovascular diseases (CVDs).

Objective: We assessed whether healthy eating lowers the risk of CVD and all-cause mortality in cardiac patients.

Design: We included 4307 patients from the Alpha Omega Trial aged 60-80 y with a clinically diagnosed myocardial infarction and monitored mortality for 10 y. Diet was assessed at baseline (2002-2006) with a validated 203-item food-frequency questionnaire. We created 2 dietary scores on the basis of nonoverlapping sets of foods: the Dutch Healthy Nutrient and Food Score (DHNaFS) and the Dutch Undesirable Nutrient and Food Score (DUNaFS). The associations of both dietary scores with CVD and all-cause mortality were assessed by using multivariable-adjusted Cox regression models.

Results: The median time after myocardial infarction at baseline was 3.7 y (IQR: 1.7-6.3 y). During a median of 6.5 y of follow-up (IQR: 5.3-7.6 y), 801 patients died; 342 of those died of CVD. One patient was lost to follow-up. A substantially higher average amount of DHNaFS foods (∼1750 g/d) than DUNaFS foods (∼650 g/d) was consumed. Almost all patients received drug treatment: 86% used statins, 90% used antihypertensive medication, and 98% used antithrombotic medication. Patients in the fifth quintile of the DHNaFS had a 30% (HR: 0.70; 95% CI: 0.55, 0.91) lower CVD risk and a 32% (HR: 0.68; 95% CI: 0.47, 0.99) lower all-cause mortality risk than did patients in the first quintile. The DUNaFS was unrelated to both CVD and all-cause mortality.

Conclusion: Beyond state-of-the-art drug treatment, healthy eating was associated with a lower risk of CVD and all-cause mortality in cardiac patients. This trial was registered at as NCT00127452.

Keywords: cardiac patients; cardiovascular disease; epidemiology; food-based dietary scores; mortality.

Publication types

  • Observational Study
  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Antihypertensive Agents / therapeutic use
  • Cardiovascular Diseases / diet therapy*
  • Cardiovascular Diseases / drug therapy
  • Cardiovascular Diseases / epidemiology
  • Cardiovascular Diseases / mortality
  • Cohort Studies
  • Combined Modality Therapy
  • Double-Blind Method
  • Elder Nutritional Physiological Phenomena*
  • Female
  • Fibrinolytic Agents / therapeutic use
  • Follow-Up Studies
  • Humans
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors / therapeutic use
  • Male
  • Mortality
  • Myocardial Infarction / mortality
  • Myocardial Infarction / prevention & control
  • Netherlands / epidemiology
  • Nutrition Policy*
  • Patient Compliance*
  • Proportional Hazards Models
  • Prospective Studies
  • Recurrence
  • Risk Factors


  • Antihypertensive Agents
  • Fibrinolytic Agents
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors

Associated data