Abstract MP53: Associations of Dietary Patterns and Cardiovascular Disease Risk Do Not Differ by Diabetes Status

Abstract

Introduction: Adults with diabetes have been shown to have differences in reported diet compared to adults without diabetes. While diet is associated with cardiovascular disease (CVD) risk, few studies have examined whether dietary patterns may differentially affect CVD risk in adults with and without diabetes. Objective: We examined whether the relationship between diet and CVD risk differed between adults with and without diabetes who were free of CVD at baseline in the REasons for Geographic and Racial Differences in Stroke (REGARDS) study. Methods: REGARDS is a nation-wide, longitudinal study of 30, 239 black and white participants ages 45 and older. Previously, principal components analysis was utilized to derive dietary patterns for participants with usable Block98 food frequency questionnaire data (n=21,636). Diabetes was defined as self-reported medication use, fasting glucose ≥ 126 mg/dL, or non-fasting glucose ≥ 200 mg/dL. The final sample for this analysis included 2,701 participants with diabetes and 13,906 participants without diabetes. CVD events, including stroke and nonfatal or fatal myocardial infarction, were physician-adjudicated. Cox proportional hazards regression was used to assess the association of each dietary pattern (modeled in quintiles) with risk of CVD, stratified by diabetes status. Results: We observed 787 CVD events over an average follow up of 5.5 years. Greater adherence to the Southern dietary pattern (which loaded highly on fried foods, processed meats, and sugar-sweetened beverages) significantly increased risk of CVD in adults without diabetes (comparing Q5 to Q1: HR=1.54; 95% CI=1.16, 2.06) and the association trended similarly, though non-significant, in adults with diabetes (comparing Q5 to Q1: HR=1.32; 95% CI=0.76, 2.31). Adherence to the Plant-based pattern (which loaded heavily on fruits, vegetables, and legumes) showed a non-significant inverse association with CVD risk in both adults with diabetes (comparing Q5 to Q1: HR=0.77; 95% CI=0.49, 1.23) and adults without diabetes (comparing Q5 to Q1: HR=0.87; 95% CI=0.65, 1.17). After adjustment for age, race, gender, region, income, education, physical activity, smoking status, and total energy intake, there were no differences in the association of either dietary pattern and risk of CVD between adults with and without diabetes (p for interaction = 0.23 for Plant-based; p for interaction = 0.87 for Southern). Conclusions: While adults with and without diabetes may differ in reported dietary practices, our results suggest there are no differences in the associations of dietary patterns and CVD risk between the two groups - further demonstrating the importance of healthful dietary practices in the prevention of CVD regardless of diabetes status.