Relationships between 'mediterranean' and 'western' dietary patterns and major cardiovascular events in patients with stable coronary heart disease in the stability study

Introduction: A 'Mediterranean' dietary pattern has been associated with lower cardiovascular mortality, but it is uncertain whether foods common in 'western' diets influence cardiovascular risk. Hypothesis: Greater consumption of foods typical of a 'Mediterranean' diet and less consumption of 'unhealthy' foods typical of 'western' diets are associated with fewer cardiovascular events. Methods: 15,482 (97.8%) of the patients with stable coronary heart disease from 39 countries who participated in the STabilisation of Atherosclerotic plaque By Initiation of darapLadIb TherapY (STABILITY) trial completed a food frequency questionnaire at baseline. A Mediterranean Diet Score (MDS) was calculated by assigning points (0 to 4) for more consumption of whole grains, fruits and vegetables, legumes, fish, and alcohol, and for less meat. A 'western diet score' (WDS) assigned points for more consumption of refined grains, sweets and deserts, sugared drinks and deep fried foods. Five Cox proportional hazards models assessed associations between MACE (cardiovascular death, non-fatal myocardial infarction or non-fatal stroke, n= 1544) and MDS or WDS after adjusting treatment group, age, sex, markers of disease severity, cardiovascular risk factors and geographic region. Results: The hazard ratio (HR) and 95% confidence intervals (CI) for MACE are reported for a 5 unit increase in MDS and WDS score in five models which adjust for different covariates in the table. Conclusion: In patients with stable coronary heart disease greater adherence to a Mediterranean dietary pattern was independently associated with fewer major cardiovascular events. 'Unhealthy' foods typical of western diets were not associated with MACE.