Abstract MP20: Dietary Quality and Mortality among Myocardial Infarction Survivors

Background: Despite the increase in the prevalence of non-fatal Myocardial Infarction (MI) in the United States, evidence based recommendations for diet post-MI are limited and established primarily from studies of short duration. Objective: Using data from the Nurses’ Health Study and the Health Professional Follow-Up Study, we assessed dietary quality, measured by the recently developed Alternative Healthy Eating Index 2010 (AHEI2010), to evaluate diet post-MI and changes in diet from pre- to post-MI in relation to all-cause and cardiovascular mortality. Method and Results: We included 2,258 women and 1,840 men who were free of cardiovascular disease, stroke or cancer at the time of enrollment (1976 for women and 1986 for men), and survived a first MI during the follow up through 2008. Individuals were free of stroke at the time of initial MI onset, provided both pre-MI exposure information and at least one post-MI food frequency questionnaire (FFQ). During follow-up, we confirmed 682 all cause and 336 cardiovascular deaths for women, and 451 all cause and 222 cardiovascular deaths for men. The median survival time after initial MI was 8.7 years for women and 9.0 years for men. The Alternative Healthy Eating Index 2010 (AHEI2010) was developed based on a comprehensive review of the relevant literature to determine foods and nutrients most consistently associated with lower chronic disease risk and has the following 11 components: vegetables, fruits, nuts and legumes, red meat and processed meats, sugar-sweetened beverages, alcohol, polyunsaturated fat (no EPA or DHA), trans fat, omega-3 fat (EPA and DHA), whole grains and sodium intake. We used Cox proportional hazards models with time since initial MI onset as the underlying time scale and adjusted for medication use, medical history, and lifestyles factors. After pooling the results from both cohorts, the adjusted HR was 0.76 (95%CI: 0.60-0.96) for all-cause mortality and 0.74 (95%CI: 0.51-1.05) for cardiovascular mortality, between the highest and lowest quintile of the AHEI2010. A greater increase in AHEI2010 score from the pre- to post-MI period comparing Q5 (highest increase) vs. Q1 (lowest increase), was significantly associated with lower all-cause mortality (pooled HR= 0.71, 95%CI: 0.55-0.90) and cardiovascular mortality (pooled HR= 0.59, 95%CI: 0.41- 0.86). Conclusions: Our results suggest that post-MI patients who consume a higher quality diet, which has been associated with lower risk of CHD in primary prevention, have lower all-cause mortality. The current dietary recommendations for secondary prevention among MI patients need to be updated to reflect current scientific knowledge and to offer comprehensive advice on overall healthy diet quality.