Prevention & lipidsCohort study
Diet, cardiovascular disease, and mortality in 80 countries
- Prospective cohort study
- multinational
- replication in five independent studies
Authors' conclusion
A diet comprised of higher amounts of fruit, vegetables, nuts, legumes, fish, and whole-fat dairy is associated with lower CVD and mortality in all world regions, especially in countries with lower income where consumption of these foods is low.
Study context
- Population
- General population in 21 countries (Prospective Urban Rural Epidemiology (PURE)), replicated in vascular patients and case-control studies from 70 countriesPURE derivation cohort
- Participants
- 147,642 participants
- Exposure
- Healthy diet score ≥5 vs ≤1 points
- Outcome
- All-cause mortality and major CV events (CVD)
- Follow-up
- Median 9.3 years
Main finding
As reported in the abstract
PURE cohort · median 9.3 years
Score ≥5 vs Score ≤1HR
mortality
0.70(95% CI 0.63–0.77)
CVD
0.82(CI 0.75–0.91)
MI
0.86(CI 0.75–0.99)
stroke
0.81(CI 0.71–0.93)
Observational data: associations, not effects.
Further findings
| Outcome | Estimate | |
|---|---|---|
| Three independent studies in vascular patients (higher vs lower score) — Higher diet score vs Score ≤1 · mortality | HR 0.73 (CI 0.66–0.81) | |
| Three independent studies in vascular patients (higher vs lower score) — Higher diet score vs Score ≤1 · CVD | HR 0.79 (CI 0.72–0.87) | |
| Three independent studies in vascular patients (higher vs lower score) — Higher diet score vs Score ≤1 · MI | HR 0.85 (CI 0.71–0.99) | |
| Three independent studies in vascular patients (higher vs lower score) — Higher diet score vs Score ≤1 · stroke, not statistically significant | HR 0.87 (CI 0.73–1.03) | |
| Two case-control studies (higher score) — Higher diet score vs Score ≤1 · first MI | OR 0.72 (CI 0.65–0.80) | |
| Two case-control studies (higher score) — Higher diet score vs Score ≤1 · stroke | OR 0.57 (CI 0.50–0.65) | |
| 0.512Ratio (log scale) |
Death or cardiovascular disease (CVD) by national income
- Significantly lower risk with higher score in lower- than higher-income regions
- P for heterogeneity < 0.0001
PURE score vs other common diet scores
- Slightly stronger associations with death or CVD
- P < 0.001 for each comparison
Original publication
Diet, cardiovascular disease, and mortality in 80 countries. Eur Heart J. Published 6 July 2023. doi:10.1093/eurheartj/ehad269
Summarised from the published abstract; every number is checked against it