Abstract P327: Adherence to the Alternative Healthy Eating Index is Associated with a Lower Risk of Acute Myocardial Infarction Among Singapore Chinese Adults

Abstract

Introduction: Adherence to the Alternative Healthy Eating Index-2010 (AHEI-2010) has been associated with lower risk of acute myocardial infarction (AMI) in Western populations. It remains unclear if this association is present in Asian populations. Little is known about potential biological mediators of the association between the AHEI-2010 and AMI. Objective: We investigated the association between adherence to the AHEI-2010 and AMI related biomarkers and their potential role as mediators of the association between the AHEI-2010 and risk of AMI in a Chinese population. Methods: We conducted a nested case-control study (subcohort: n=2,198; verified AMI events: n=751) within a large prospective cohort of Singapore Chinese established between April 1993 and December 1998 involving Chinese men and women aged 45-74 years. Habitual diet was assessed with baseline in-person interviews using a validated, semi-quantitative food frequency questionnaire. Cases were ascertained via linkage with nationwide hospital databases and Singapore Birth and Death Registry. We evaluated the association between the AHEI-2010 and several AMI related biomarkers, such as HbA1c, markers of dyslipidemia (low-density lipoprotein, high-density lipoprotein and triglycerides) and inflammation (C-reactive protein), and blood pressure measurements. A conditional logistic regression model was used to estimate the odds ratios and 95% confidence intervals of AMI risk associated with quartiles of AHEI-2010 scores adjusting for potential confounders. Results: We documented 751 incident AMI events (nonfatal AMI=564; fatal AMI = 288). There were 489 AMI events observed in men and 262 AMI events in women. The AHEI-2010 was inversely associated with the risk of AMI (P trend =0.001) in a dose-dependent manner. Compared to the lowest quartile, participants in the highest quartile had a 37% reduction in the AMI risk (OR: 0.63; 95% CI: 0.48, 0.82). Favorable associations were more evident in men (OR: 0.57; 95% CI: 0.40, 0.80) than women (OR: 0.81; 95% CI: 0.51, 1.28). Further adjustments of single biomarkers and their combinations as potential intermediates in the multivariable models did not explain the association between AHEI-2010 and AMI risk (OR: 0.61; 95% CI: 0.44-0.83). Conclusion: In the Singapore Chinese adult population, greater adherence to the AHEI-2010 is associated with a lower risk of AMI. The inverse dose-dependent association between AHEI-2010 and AMI risk was not explained by the potential biological intermediates evaluated in this study.