Relationship of the Healthy Diet Characteristics Recommended by the 2021 ESC Guidelines with Vascular Events in Patients with Established CVD

Aims: To evaluate to which extent patients with cardiovascular disease (CVD) report a diet in line with the Healthy Diet Characteristics recommended by the 2021 European Society of Cardiology guidelines on CVD prevention. To quantify the relationship between these diet characteristics and risk of cardiovascular events in patients with established CVD. Methods and results: Data from 2553 patients with established CVD included in the UCC-SMART-cohort was used. Diet, except for salt intake, was quantified using a food frequency questionnaire. Cox regression adjusted for age, sex, lifestyle and energy-intake quantified the relationship between the Healthy Diet Characteristics and the risk of non-fatal vascular events (stroke and myocardial infarction). Patients (aged 59 ± 9 years; 22% female; median body mass index 26 kg/m² [25–75th percentile: 24–29 kg/m²] reported a diet which was in line with a median of 4 out of 11 Healthy Dietary Characteristics (25–75th percentile: 3–5). Fifty-eight percent reported eating at least 100 grams of fish per week. Sixteen percent reported a vegetable intake ≥200 grams/day, 12% a saturated fat intake below 10 energy-percent and 19% a more plant-based diet. Higher compliance with the Healthy Diet Characteristics was associated with a lower risk of non-fatal vascular events (209 events per 24 212 person-years; HR 0.89, 95% CI: 0.82–0.98) on average for each additional Healthy Dietary Characteristic. Conclusion: Patients with established CVD reported adhering to a median of 4 out of 11 Healthy Diet Characteristics and adhering to these was related to a lower risk of combined non-fatal stroke and myocardial infarction.