P5321Micronutrient intake and adherence to DASH diet are associated with incident major adverse cardiovascular events and all-cause mortality in a bi-ethnic population

Abstract

Background: Information on dietary intake can contribute to our understanding of diet-cardiovascular disease (CVD) health associations and ethnic health disparities, but data are lacking for Jews and Arabs in Israel. Purpose: To evaluate associations between baseline dietary habits and incident major adverse cardiovascular events (MACE) and all-cause mortality in a cohort of Jewish and Arab adults, followed for a mean period of 11 years. Methods: A prospective cohort study collecting follow-up data on hospital admissions for MACE and morality from any cause for the Hadera District Study (HDS) participants (n=883). The baseline HDS sample was randomly selected from the urban Hadera District population in Israel, stratified equally by ethnicity (Jews/Arabs), sex, and age (range: 25-64 years). Associations between baseline dietary intake (collected from 2002-2007) and the outcome variables were evaluated in multivariable analyses. Results: Arabs reported higher baseline total energy and carbohydrate intakes and lower intakes of protein, total fat and most micronutrients than Jews, as well as lower adherence to a DASH (Dietary Approaches to Stop Hypertension) dietary pattern. The risk of MACE increased with higher baseline sodium-potassium ratios (HR: 3.82; 95% CI: 1.52-9.56), but decreased with higher baseline intakes of fiber (HR per 1 g increment/1000 kcal: 0.89; 95% CI: 0.81-0.98), and calcium (HR per 100 mg increment/1000 kcal: 0.79; 95% CI: 0.63-0.99). In addition, a higher baseline DASH score was protective against MACE (HR: 0.71; 95% CI: 0.56-0.89), and marginally protective against mortality (HR: 0.79; 95% CI: 0.62-1.01). The baseline sodium-potassium ratio and poly-unsaturated fatty acid and magnesium intakes were associated with mortality risk in models adjusting only for demographic factors. In the fully adjusted mortality models, including also baseline morbidity and socio-economic and lifestyle factors, only baseline magnesium intake remained associated with reduced risk of mortality (HR per 100mg increment/ 1000 kcal: 0.35; 95% CI: 0.14-0.87). In the fully adjusted models, Arabs were at higher risk than Jews for MACE but not for all-cause mortality. Conclusions: A healthy long-term macro and micronutrient intake profile, and adherence to healthy dietary patterns (e.g., DASH), can contribute to reducing cardiovascular events and all-cause mortality among Jews and Arabs in Israel.