A diet comprised of higher intakes of fruit, vegetables, nuts, legumes, fish, dairy and meats was associated with lower incidences of cardiovascular disease and mortality worldwide, based on data from the PURE study presented Aug. 28 at ESC Congress 2018. Elements of these findings differ from current diet advice derived from previous studies conducted largely in high-income countries.

More than 218,000 participants in five studies from over 50 countries in five continents were divided into five groups based on the quality of their diet. A dietary quality score was developed based on foods associated with a lower risk of death in previous studies (fruit, vegetables, nuts, legumes, fish, dairy products and meat). Researchers then compared the risks of cardiovascular disease and death in those with the highest quality diet (18 points or more) with the poorest quality diet (11 points or less).

All told, there were 6,821 deaths and 5,466 major cardiovascular events (death from cardiovascular causes, nonfatal myocardial infarction, stroke, heart failure) over the median follow-up of 9.1 years among PURE trial participants. Across participants in all five studies, the highest quality diet was associated with lower risks of major cardiovascular events, including stroke, cardiovascular death and non-cardiovascular death. Results were consistent across those patients with and without cardiovascular disease.

"People who consumed a diet emphasising fruit, vegetables, nuts, legumes, fish, dairy products, and meat had the lowest risks of cardiovascular disease and early death," said Andrew Mente, MD, co-principal investigator. "Regarding meat, we found that unprocessed meat is associated with benefit."

Based on the PURE findings, researchers suggest people around the world should limit the amount of refined carbohydrates and note that dairy foods and unprocessed meat can be included as part of a healthy diet. "Thinking on what constitutes a high quality diet for a global population needs to be reconsidered," said Salim Yusuf, DPhil, FACC, senior author. "For example, our results show that dairy products and meat are beneficial for heart health and longevity. This differs from current dietary advice."

In addition to PURE, the other four studies involved in testing the PURE healthy diet score included ONTARGET, TRANSCEND, INTERHEART and INTERSTROKE.

According to Gaurav Sharma, MD, and Andrew M. Freeman, MD, FACC, “Studies like this are very interesting and can add to the knowledgebase, but should be interpreted with caution, particularly when comparing multiple countries with marked differences in socioeconomic status as well as food preparation differences. The findings regarding red meat and dairy consumption in the PURE diet score should be taken with reservation. Findings from other randomized and observational studies demonstrating adverse cardiovascular outcomes with increased animal fat consumption should not be displaced just yet — more work is still needed.”

Clinical Topics: Acute Coronary Syndromes, Prevention, Stable Ischemic Heart Disease, Diet, Chronic Angina

Keywords: ESC18, ESC Congress, Acute Coronary Syndrome, Angina, Stable, Diet, Risk