Compliance with the DASH diet and risk of all-cause and cardiovascular mortality in patients with myocardial infarction.
Study Goal
The researchers aimed to assess the relationship between compliance with the DASH diet and cardiovascular and all-cause mortality risk in patients with established cardiovascular disease (CVD).
Results Summary
The study found no significant association between DASH compliance and all-cause mortality (HR 0.92) or cardiovascular mortality (HR 0.90) in patients with a history of myocardial infarction. The DASH diet's effects may have been modified by concomitant use of blood pressure-lowering medications.
Population
Patients with a history of myocardial infarction (79% male, median age 69 years, >80% on lipid- and blood pressure-lowering medication).
Effective Dosage
Compliance score ≥5 out of 9 (specific dietary details not provided).
Duration
Median follow-up of 12.4 years.
Interactions
Possible modification of effects by blood pressure-lowering medications.
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
Dietary Approaches to Stop Hypertension (DASH) diet | decrease | blood pressure | - | - | has been shown to effectively reduce | #1 |
Dietary Approaches to Stop Hypertension (DASH) diet | decrease | body weight | - | - | has been shown to effectively reduce | #2 |
compliance with the DASH diet | no change | all-cause mortality | patients with a history of myocardial infarction (MI) | HR 0.92, 95%CI 0.80-1.06 | was not associated with | #3 |
compliance with the DASH diet | no change | cardiovascular mortality | patients with a history of myocardial infarction (MI) | HR 0.90, 95%CI 0.72-1.11 | was not associated with | #4 |
compliance with the DASH diet | no change | risk of all-cause mortality | patients with a history of MI | - | no relation was found between | #5 |
compliance with the DASH diet | no change | risk of cardiovascular mortality | patients with a history of MI | - | no relation was found between | #6 |
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.