Entry #: 41
Date: 13 March 2018
Section: Mediterranean diet
Topic: Diet and coronary artery calcification
Type: Human trial
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D. Elizabeth McCord, Nancy B. Ray and Tom C. Karagiannis
Association of dietary patterns with five-year degree and progression of coronary artery calcification in the Heinz Nixdorf recall study
Frölich et al
Citation / Year
(1) / 2017
Mediterranean diet, dietary patterns, food frequency patterns, Heinz Nixdorf recall study, coronary artery calcification, coronary heart disease
Accumulated evidence indicates that dietary patterns play an important role in the prevention of cardiovascular disease which represents a major cause of premature disability and mortality. Progressive cardiovascular atherosclerotic disease is one of the main pathologies associated with heart disease, and levels of coronary artery calcification are associated with myocardial infarction and mortality (2, 3). Subclinical atherosclerosis, and progression of coronary artery calcification can be assessed by noncontrast-enhanced electron-beam computed tomography (CT) scans (4, 5). This was the methodology employed in this work, to classify coronary artery calcification into slow, expected, and rapidly progressing pathologies. It has been shown that diet is a modifiable risk factor associated with coronary heart disease and progression of coronary artery calcification. For example, associations with processed meat consumption, high saturated fat, and low fibre consumption and coronary artery calcification, have been made (6). Further, rapid progression of coronary artery calcification and high alcohol consumption has been observed (7). In this interesting work, a large population-based study was utilised to investigate the association between progression of coronary artery calcification and dietary patterns.
Key points and implications
This study is part of the relatively large (n = 4814), Heinz Nixdorf recall study, which represents a study with the aim of essentially developing predictive models of myocardial infarction and cardiac death based on assessment of subclinical (silent) heart disease and novel risk factors. This is work represents advanced computational and statistical analyses to firstly cluster the cohort into the different dietary patterns. Following two rounds of exclusion based on appropriate criteria, the final cohort (n = 3427), was stratified at baseline, into five subjective dietary patterns based on food frequency questionnaires. These were the: 1) Health conscious, 2) traditional German/less alcohol, 3) Mediterranean-like, 4) Western, and 5) Animal fat/alcohol. Coronary artery calcification was monitored after an average follow-up time of 5.1 years, and the cohort was stratified into the slow, expected, and rapidly progressing groups. Detailed statistical analyses using multiple linear regression models (three different stratification models) were used to compute the association between dietary patterns at baseline and progression of coronary artery calcification. Given the complex and detailed nature of the statistical and modelling analyses a number interesting associations were made, and key finding was that the risk for rapid coronary artery calcification progression in people with a Mediterranean-like diet at baseline was 40% less than people within the animal fat/high alcohol dietary pattern. Overall, this is an important study leveraging a relatively large-scale population cohort, and performing advanced analyses, to associate dietary patterns and progression of coronary artery calcification. It provides further evidence for the potential of the Mediterranean diet and the prevention of cardiovascular disease, and provides the basis for further research in the field.
- S. Frolich et al., Association of dietary patterns with five-year degree and progression of coronary artery calcification in the Heinz Nixdorf Recall study. Nutrition, metabolism, and cardiovascular diseases : NMCD 27, 999-1007 (2017).
- R. Erbel et al., Coronary risk stratification, discrimination, and reclassification improvement based on quantification of subclinical coronary atherosclerosis: the Heinz Nixdorf Recall study. Journal of the American College of Cardiology 56, 1397-1406 (2010).
- N. Lehmann et al., Accelerated progression of coronary artery calcification in hypertension but also prehypertension. Journal of hypertension 34, 2233-2242 (2016).
- R. Erbel et al., Progression of coronary artery calcification seems to be inevitable, but predictable – results of the Heinz Nixdorf Recall (HNR) study. European heart journal 35, 2960-2971 (2014).
- A. Schmermund et al., Assessment of clinically silent atherosclerotic disease and established and novel risk factors for predicting myocardial infarction and cardiac death in healthy middle-aged subjects: rationale and design of the Heinz Nixdorf RECALL Study. Risk Factors, Evaluation of Coronary Calcium and Lifestyle. American heart journal 144, 212-218 (2002).
- J. A. Nettleton et al., Associations between markers of subclinical atherosclerosis and dietary patterns derived by principal components analysis and reduced rank regression in the Multi-Ethnic Study of Atherosclerosis (MESA). The American journal of clinical nutrition 85, 1615-1625 (2007).
- R. L. McClelland et al., Alcohol and coronary artery calcium prevalence, incidence, and progression: results from the Multi-Ethnic Study of Atherosclerosis (MESA). The American journal of clinical nutrition 88, 1593-1601 (2008).