Dietary Pattern in Women Linked to Cardiovascular, All-Cause Mortality

Women who eat a diet rich in vegetables, fruits, legumes, whole grains, fish and poultry may reduce their risk for death from cardiovascular disease and from all causes, according to the results of a prospective study reported in the June 23 Online First issue of Circulation. In contrast, women who follow a traditional "Western" diet of red and processed meat, refined grains, french fries, and sweets may increase their risk.

"The impact of overall dietary patterns that reflect actual eating behaviors on mortality caused by cardiovascular or other chronic diseases is largely unknown," write Christin Heidemann, DrPH, MSc, from Harvard School of Public Health in Boston, Massachusetts, and colleagues. "The aim of the present study was to evaluate the potential impact of major dietary patterns derived by factor analysis on subsequent risk of mortality resulting from CVD [cardiovascular disease], cancer, and all causes in a large cohort study of women."

The investigators studied the relationship between dietary patterns and the risk for cardiovascular, cancer, and all-cause mortality in 72,113 women who at baseline were free of myocardial infarction, angina, coronary artery surgery, stroke, diabetes mellitus, or cancer. During follow-up from 1984 to 2002, dietary patterns were derived by factor analysis according to validated food frequency questionnaires administered every 2 to 4 years.

There were 2 predominant dietary patterns: "prudent," with high intakes of vegetables, fruit, legumes, fish, poultry, and whole grains; and "Western," with high intakes of red meat, processed meat, refined grains, french fries, and sweets or desserts.

Of 6011 deaths occurring during 18 years of follow-up, there were 1154 cardiovascular deaths and 3139 cancer deaths. For the highest quintile vs the lowest quintile of prudent diet scores, there was a 28% lower risk for cardiovascular mortality (95% confidence interval [CI], 13% - 40%) and a 17% lower risk of all-cause mortality (95% CI, 10% - 24%) after multivariable adjustment.

However, the Western pattern was linked to a higher risk for mortality from cardiovascular disease (22%; 95% CI, 1% - 48%), cancer (16%; 95% CI, 3% - 30%), and all causes (21%; 95% CI, 12% - 32%).

Limitations of this study include inability to test optimal diets that could have the greatest effect on mortality rate, problem inherent in factor analysis, possible residual confounding, observational design, and homogeneous study population.

"Greater adherence to the prudent pattern may reduce the risk of cardiovascular and total mortality, whereas greater adherence to the Western pattern may increase the risk among initially healthy women," the study authors write. "These data highlight the importance of health professional and public health efforts to help to adopt healthy overall dietary patterns including high intakes of plant foods such as vegetables, fruit, legumes, and whole grains; high intakes of fish and poultry; and low intakes of red and processed meat, refined grains, french fries, and sweets."