Compliance with the DASH diet and risk of all-cause and cardiovascular mortality in patients with myocardial infarction

Nadia E Bonekamp; Esther Cruijsen; Frank Lj Visseren; Yvonne T van der Schouw; Johanna M Geleijnse; Charlotte Koopal

doi:10.1016/j.clnu.2023.06.033

Compliance with the DASH diet and risk of all-cause and cardiovascular mortality in patients with myocardial infarction

Clin Nutr. 2023 Aug;42(8):1418-1426. doi: 10.1016/j.clnu.2023.06.033. Epub 2023 Jul 5.

Authors

Nadia E Bonekamp¹, Esther Cruijsen², Frank Lj Visseren³, Yvonne T van der Schouw⁴, Johanna M Geleijnse², Charlotte Koopal¹

Affiliations

¹ Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
² Division of Human Nutrition and Health, Wageningen University, Wageningen, the Netherlands.
³ Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands. Electronic address: F.L.J.Visseren@umcutrecht.nl.
⁴ Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.

PMID: 37433229
DOI: 10.1016/j.clnu.2023.06.033

Abstract

Background & aims: The Dietary Approaches to Stop Hypertension (DASH) diet has been shown to effectively reduce blood pressure and body weight, but its effectiveness for reducing (cardiovascular) mortality rates has never been assessed in a clinical trial. Causal effects of dietary interventions are difficult to measure, due to practical limitations of randomized controlled diet trials. Target trial emulation can be used to improve causal inference in observational data. The aim of this study was to emulate a target trial assessing the relationship between compliance with the DASH diet and cardiovascular and all-cause mortality risk in patients with established CVD.

Methods: Using data from the Alpha Omega Cohort, we emulated a DASH diet trial in patients with a history of myocardial infarction (MI). Inverse probability of treatment weighting (IPTW) was used to balance confounders over DASH-compliant and non-DASH-compliant participants. Hazard ratios (HRs) were estimated with IPT-weighted Cox models.

Results: Of 4365 patients (79% male, median age 69 years, >80% treated with lipid- and blood pressure-lowering medication), 598 were classified as DASH-compliant (compliance score ≥5 out of 9). During a median follow-up of 12.4 years, 2035 deaths occurred of which 903 (44%) were of cardiovascular origin. DASH compliance was not associated with all-cause mortality (HR 0.92, 95%CI 0.0.80-1.06) and cardiovascular mortality (HR 0.90, 95%CI 0.72-1.11).

Conclusions: In an emulated target trial on the DASH diet in the Alpha Omega cohort no relation was found between DASH compliance and risk of all-cause and cardiovascular mortality in patients with a history of MI. The DASH diet's effects may have been modified in this population by concomitant use of blood pressure-lowering medications.

Keywords: Cardiovascular disease; DASH diet; Inverse probability of treatment weighting; Nutrition; Propensity score; Target trial emulation.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Blood Pressure
Cardiovascular Diseases*
Diet
Dietary Approaches To Stop Hypertension*
Female
Humans
Hypertension* / epidemiology
Male
Myocardial Infarction* / complications
Patient Compliance

Grants and funding

R01 HL076200/HL/NHLBI NIH HHS/United States