The authors raise the following question: How do dietary patterns affect the risk of recurrent major adverse cardiovascular events (MACE) and major adverse limb events (MALE) in patients with coronary (CAD) and peripheral artery disease (PAD)?
Previous manuscripts like the one by De Lorgeril M, et al “Mediterranean diet, traditional risk factors, and the rate of cardiovascular complications after myocardial infarction: final report of the Lyon Diet Heart Study”. Circulation 1999;99:779–785, revealed the importance of the Mediterranean diet for the protection from cardiovascular events. Methodologically, the assessment of dietary quality was made by using a short food frequency questionnaire (FFQ) that contained 31 items with pre-defined portion sizes, once, at the baseline visit. Participants, patients from the COMPASS trial cohort, were asked ‘In the last 12 months, how often did you eat foods from each of the following categories?’ Finally authors generated two dietary scores: modified Alternate Healthy Eating Index (mAHEI) and a modified Mediterranean diet score (mMDS). The primary outcome was a composite incidence of either MACE (cardiovascular death, myocardial infarction, or stroke) or MALE [severe limb ischaemia leading to an intervention (acute and chronic limb ischaemia) and major vascular amputation] using the definitions reported in the COMPASS trial.
As a result, the incidence of the MACE and MALE composite outcome was highest in patients with a poor diet quality. As the authors acknowledge in the discussion “While societal guidelines have highlighted dietary optimization as a key aspect of non-pharmacologic therapy in PAD, there is minimal evidence to describe the impact of dietary intake on vascular outcomes specific to the peripheral arterial beds” and this is the aspect that makes the study different and relevant. Authors remark that the emphasis should be shifted to improving overall dietary quality by suggesting greater consumption of fruits, vegetables, nuts, higher fiber foods, choosing white over red meat, and consumption of minimally processed foods. As a conclusion, this analysis suggests that a low dietary quality is an independent risk factor for MACE and MALE in patients with established CAD and/or PAD. Finally the take home message is that Dietary quality is an important risk factor associated with recurrent vascular events.
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