Abstract P221: Diet Quality and Incidence of Coronary Heart Disease and Coronary Revascularization Among US Women and Men With Hypertension

Abstract

Background: Hypertension affects 45% of American adults and is a major risk factor for cardiovascular disease. Regrettably, about less than half of all affected individuals have their hypertension controlled. Healthy dietary patterns have been associated with a lower risk of cardiovascular disease in the general population. However, less is known about this association among individuals with hypertension. Aim: To study four diet quality scores, the alternate Mediterranean Diet (aMED) score; the alternate Healthy Eating Index 2010 (aHEI-2010); the Dietary Approaches to Stop Hypertension (DASH) score; and a Healthful Plant-based Diet Index (hPDI) and the incidence of coronary heart disease (CHD) and coronary revascularization (bypass, angioplasty or stent) among US women and men with hypertension. Methods: We included 22,270 women from the Nurses’ Health Study and 9,846 men from the Health Professionals Follow-up Study that had reported a professionally-diagnosed incident hypertension in 1988 or on subsequent biennial questionnaires. At inclusion, participants were free of other chronic diseases (CHD, coronary artery bypass/angioplasty/stent, angina, other heart disease, stroke, diabetes and cancer). Dietary data were collected every 4 years using a validated semi-quantitative food frequency questionnaire and covariate data were collected biennially. Using the cumulative average of dietary intake after hypertension diagnosis, we calculated hazard ratios (HR, 95% CI) comparing quintiles 5 to 1 of each diet quality score with multivariable Cox proportional hazards regression while adjusting for age, energy intake, alcohol (DASH and hPDI only), margarine (hPDI only), smoking, BMI, physical activity, family history of CHD, lipid-lowering medication, NSAIDs, postmenopausal hormone use (women) and hypertension medication. Results: We documented 922 incident CHD cases (299,520 person-years) and 1845 incident coronary revascularization cases (298,463 person-years) during follow-up. In pooled multivariable analyses, high adherence to all diet quality scores was inversely associated with risk of CHD (aMED: 0.73, 95% CI 0.59-0.91, p trend: <0.01; aHEI-2010: 0.66, 95% CI 0.53-0.82, p trend: <0.0001; DASH: 0.65, 95% CI 0.52-0.83, p trend: <0.0001; hPDI: 0.78, 95% CI 0.61-0.99, p trend: 0.01) and coronary revascularization (aMED: 0.83, 95% CI 0.71-0.96, p trend: 0.02; aHEI-2010: 0.80, 95% CI 0.69-0.94, p trend: <0.001; DASH: 0.88, 95% CI 0.75-1.03, p trend: 0.10; hPDI: 0.81, 95% CI 0.69-0.96, p trend: 0.07). Conclusions: This study suggests that individuals with hypertension may experience a lower risk of CHD and coronary revascularization with high adherence to healthy dietary patterns. Promoting healthy dietary habits among individuals with hypertension could be a cost-efficient and safe way to prevent the incidence of CHD and coronary revascularization.