Nutritional Pearl: Eating Healthier After a Heart Attack

Joe is a 53-year-old man with obesity who recently had a heart attack. He is concerned about his risk of having a second heart attack, but when you suggest that he improve his diet, he says, “Isn’t it a little late for that at this point?”

How do you advise your patient?
(Answer and discussion on next page)

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Answer: It's never too late to improve your diet and live both healthier and longer.

There is good research to show that once you've had a heart attack, you can reduce your risk of having another heart attack (or a stroke or other cardiovascular event) by up to 35% by quitting smoking, exercising regularly, and improving your diet. While quitting smoking and exercising regularly is pretty straightforward, improving your diet, as you probably know, can be confusing. This may explain why less than half of those who have heart disease report following a healthy diet.

Part of the problem may also be that people are still told what “not” to eat, when eating healthy is just as much (or more) about what you “should” eat. Given that there's so much more great research now about what really constitutes a healthy diet, how much does improving your diet—by today's "healthy diet" standards—affect your risk of death or another cardiovascular event?

The Research

Research published in JAMA Internal Medicine makes use of information gathered through the Nurses' Health Study and the Health Professionals Follow-Up Study, both large-scale groups of people who started responding to health, lifestyle, and dietary questionnaires every other year starting as early as 1976 and continuing through the present. For this particular research, the scientists limited their pool of participants to those men and women who had been diagnosed with a heart attack at some point in the course of the study.

The participants' diets, both before and after their heart attack, were evaluated according to a scale known as the Alternative Healthy Eating Index 2010 (AHEI2010), which is based on a comprehensive look at the studies of foods and nutrients that are most often associated with a lower risk of chronic diseases. As you might imagine, it bears a strong resemblance to a Mediterranean-style diet: vegetables, fruits, nuts and legumes, red meat and processed meats, whole grains, alcohol, and omega-3 fats and unsaturated fats. Two items that do not appear in the classic Mediterranean Diet Score are sugar-sweetened beverages and sodium intake.

The researchers could then compare the quality of each person's diet both before and after the study, looking at whether and how much their diet had changed. Finally, the diets of those who died of any cause were compared with those who were still alive at the chosen end date for this particular study.

The Results

After taking into account such variables as cholesterol medications, the participants' overall health history, and lifestyle factors such as whether they smoked, they found that after their heart attack, those whose diet scored the best according to the AHEI2010 were 24% less likely to die from all causes and 26% less likely to die from a heart-disease-related issue (like another heart attack or a stroke) than those with the poorest dietary scores. Even more interesting is that those who improved their quality of diet the most, from very poor before the heart attack to very good afterward, were 30% less likely to die from any cause and 40% less likely to die from a heart-disease-related problem.

What’s the “Take-Home”?

Even for patients with heart disease now or who have already had a heart attack, it's never too late to improve your diet and live both healthier and longer.

Reference:
Li S, Chiuve SE, Flint A, et al. Better diet quality and decreased mortality among myocardial infarction survivors. JAMA Intern Med. 2013;173(19):1808-1819.