Adherence to healthy dietary patterns improves long-term survival after a myocardial infarction (MI), as shown in a study with more than 15 years of follow-up.
The risk of all-cause mortality decreased by between 23 percent to 33 percent with the highest vs lowest quintile of post-MI dietary score for the following:
Each 1-standard deviation increase in each dietary score after MI correlated with a reduction of 7 percent to 15 percent in total mortality. [Circulation 2026;doi:10.1161/CIRCULATIONAHA.126.079972]
When comparing dietary scores before and after MI, improved adherence to AHEI was associated a 14-percent lower risk of total mortality (HR, 0.86, 95 percent CI, 0.76–0.97). Conversely, decreased adherence to most patterns was associated with increased mortality risk, with HRs ranging from 1.18 for rEDI for hyperinsulinemia to 1.45 for AHEI.
Similar associations were observed for CVD mortality and recurrent nonfatal MI.
“Overall, our findings provide evidence that adopting healthy dietary patterns explicitly emphasizing diet quality confers benefits for secondary prevention of deaths among MI survivors,” said first author Dr Le Ma and colleagues from the Harvard T.H. Chan School of Public Health in Boston, Massachusetts, US.
“The data also support the current American Heart Association dietary recommendations that focus on key healthy foods/nutrients as the cornerstone for a possibly much wider spectrum of dietary practices that incorporate personal preferences for improving cardiovascular health,” Ma and colleagues added.
The role of clinicians
“The consistency across multiple operational definitions of healthy eating analysed by Ma and colleagues serves as a reminder that there is more concordance than cacophony when defining a healthy dietary pattern,” wrote Drs Valerie Sullivan and Lawrence Appel, both from Johns Hopkins University in Baltimore, Maryland, US, in an accompanying editorial. [Circulation 2026;doi:10.1161/CIRCULATIONAHA.126.081223]
“Clinicians carry both the responsibility and the authority to convey that diet meaningfully alters the course of disease,” Sullivan and Appel noted.
While clinicians lack the time or training to deliver intensive nutritional counselling to patients, they can serve as “advocates” for making dietary changes, Sullivan and Appel continued.
“[Clinicians can] provide a basic set of high-confidence messages supported by science and reinforced by the work of Ma and colleagues, [as well as] guide their patients to credible sources of dietary advice, ideally a registered dietitian nutritionist, for more intensive individualized medical nutrition therapy,” they said.
The study included 3,277 women from the Nurses’ Health Study and 2,618 men from the Health Professionals Follow-Up Study who survived a nonfatal MI. The mean age at MI diagnosis was 68.2 years, and 95.7 percent of them were White.
Diet was assessed using validated food frequency questionnaires and updated every 2 to 4 years. Participants with higher vs low dietary scores were more likely to be physically active, have lower BMI, and use postmenopausal hormones (women), and were less likely to be current smokers. Higher dietary scores were also associated with greater intake levels of vegetables, fruits, whole grains, and nuts/legumes, and lower consumption of refined grains and red/processed meats.
Over a mean follow-up of 15.7 years after MI, a total of 3,858 deaths (65.4 percent) occurred, including 1,639 cardiovascular disease deaths (42.5 percent).