Dietary patterns and smoking and heart disease in women - Cardiovascular Disease

Nutrition Research Newsletter, March, 2004

Cardiovascular disease (CVD), specifically coronary heart disease (CHD), is the leading cause of morbidity and mortality among American women. Given the aging population, heart disease is expected to have an even greater adverse impact on women's health. Established risk factors for women--other than age--include elevated total cholesterol and blood pressure levels, lower high density lipoprotein (HDL) levels, diabetes and smoking, all of which may be controlled through dietary and lifestyle behaviors. The identification of ideal candidates for primary prevention and the development of effective, noninvasive interventions for CVD risk reduction are public health priorities.

Carotid artery stenosis is a subclinical marker of systemic atherosclerosis. Carotid ultrasonography is a well-recognized, noninvasive method for estimating subclinical atherosclerosis. In this recent study, the authors examined the associations between dietary behavior patterns, CVD risk factor profiles, and the presence of subclinical heart disease--defined in terms of carotid atherosclerosis measured by ultrasonography at 12 years of follow-up in Framingham Offspring-Spouse (FOS) women.

One thousand four hundred and twenty-three women in the population-based FOS study cohort, who were free of CVD at baseline, were included in this study. Dietary patterns were characterized using cluster analysis applied to food consumption data derived from the Framingham food frequency questionnaire (FFQ). CVD risk factors are routinely assessed at all Framingham exams. The presence of subclinical heart disease was assessed using carotid atherosclerosis (stenosis > 25%) measured by ultrasound at 12-year follow-up.

Women who ate a heart-healthy diet had favorable baseline CVD risk factor profiles. Heart-healthy women consumed adequate amounts of fruit, vegetables and dairy products. They used fats, oils, and sweets sparingly and did not overindulge in sources of dietary protein. Heart-healthy women were older, had lower total-to-LDL cholesterol levels and higher total-to-HDL cholesterol ratios, were less likely to be current smokers and had lower lifetime cigarette exposure. Only 7% of heart-healthy women had subclinical heart disease at follow-up, compared with 11% in all other women. In age-adjusted analyses, heart-healthy women were 40% less likely to have subclinical CVD compared with those whose diets were less heart-healthy. In analyses stratified by smoking status, women who consumed a heart-healthy diet and who had never smoked had more than 80% less chance for subclinical heart disease, compared with smokers whose diets were less heart-healthy.

Findings from this study indicate that a public health priority for women to promote the primary prevention of heart disease is the adoption of positive lifestyle behaviors, especially healthful eating and the avoidance of smoking. The authors acknowledge that due to the low proportion of minorities in this population the results may be limited to the white population. However, these findings emphasize the importance of additional research that explores the association between dietary patterns and health outcomes in more diverse populations.

Barbara Millen, Paula Quatromoni, Byung-Ho Nam, et al. Dietary patterns, smoking, and subclinical heart disease in women: Opportunities for primary prevention from the Framingham Nutrition Studies. JADA 104:208-214 (February 2004) [Address correspondence to: Barbara E. Millen, DPH, RD, FADA, Department of Social and Behavioral Sciences, Boston University School of Public Health, 715 Albany St, Talbot 263 West, Boston, MA 02118. E-mail: bmillen@bu.edu]