Dietary patterns, smoking, and subclinical heart disease in women: Opportunities for primary prevention from the Framingham nutrition studies

Objectives To investigate the relationship between a heart-healthy dietary pattern and subclinical heart disease in women, and to identify potential opportunities for primary prevention. Design Prospective analysis in which dietary patterns and cardiovascular disease (CVD) risk factors were assessed at baseline. Presence of subclinical heart disease was assessed using carotid atherosclerosis (stenosis greater than or equal to25%) measured by ultrasound at 12-year follow-up. Subjects/Setting We studied 1,423 women in the population-based Framingham Offspring/Spouse (FOS) Study cohort, Framingham, Massachusetts. Subjects did not have CVD at baseline. Statistical Analyses CVD risk factor differences among the dietary clusters were evaluated using analysis of covariance and logistic regression. The relationship between heart-healthy and less heart-healthy dietary patterns and the presence of subclinical heart disease at follow-up was examined using odds ratios calculated from multivariate logistic regressions; stratification by smoking status (current, former, never) was also explored. Results Women who ate a heart-healthy diet had more favorable baseline CVD risk factor profiles. The age-adjusted odds of subclinical heart disease at follow-up was 40% lower for heart-healthy women (OR 0.60, P=.02). Multivariate adjustment for BMI, blood lipid levels, and blood pressure only slightly attenuated these odds. The odds remained reduced after adding pack-years of smoking to the multivariate model, but statistical significance was attenuated (OR 0.74, P=.20). In analyses stratified by smoking status, women who consumed a heart-healthy diet and who had never smoked had more than 80% less odds for subclinical heart disease compared with smokers whose diets were less heart-healthy (adjusted OR 0.17; P=.0001). Conclusions Women who achieve a heart-healthy eating pattern, in combination with the avoidance of smoking, have a lower odds of subclinical heart disease. Among former smokers, the avoidance of smoking seemed to have somewhat more influence than diet on stenosis risk. A public health priority for women to promote the primary prevention of heart disease is the adoption of positive lifestyle behaviors, especially healthful eating (dietary, patterns rich in fruits, vegetables, low-fat dairy foods, leaner protein sources, and lower in fats) and the avoidance of smoking.