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Challenging conventional thinking on a healthy diet: Data from PURE

ESC Congress News 2018 - Munich, Germany

In a Hot Line session yesterday, Doctor Andrew Mente (Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada) presented the results of an analysis in 218,000 people from over 50 countries based on four large international studies to clarify the type of modern, international diet that promotes cardiovascular (CV) health and longevity.

Nutrition, Malnutrition and Heart Disease
Risk Factors and Prevention

mente-andrew-2018.jpg“Contrary to what has been believed for decades,” says Dr. Mente, “the Prospective Urban Rural Epidemiology (PURE) study revealed that a high-carbohydrate diet increases the risk of mortality but that fats are associated with a lower risk of total mortality and stroke.(1) It also established that the protective effect of fruit, vegetables and legumes extends globally.(2)”

The PURE cohort includes over 138,000 individuals without cardiovascular disease (CVD) from 21 countries in five continents. In order to clarify the constituents of a healthy diet, intake was recorded using country-specific food frequency questionnaires at baseline and patients were followed for a median of 8.1 years. “Dietary quality scores were based on foods associated with a lower risk of mortality, such as fruit, vegetables, legumes, nuts, fish, dairy products and unprocessed meat,” Dr. Mente says, explaining, “The association between diet and CVD was first examined in the PURE cohort and then validated in 79,478 patients in a prospective study in vascular disease (ONTARGET/TRANSCEND) and two case-control studies in first myocardial infarction (MI) (INTERHEART) and first stroke (INTERSTROKE).”

There were 5,466 major CV events—death from CV causes, non-fatal MI, stroke and heart failure—and 6,821 total deaths. After adjusting for confounding factors, higher-quality diets (≥18 points) were associated with a lower risk of major CV events (hazard ratio [HR] 0.89; p=0.0193), stroke (HR 0.83; p=0.0402), CV mortality (HR 0.71; p<0.0001), non-CV mortality (HR 0.74; p<0.0001) and total mortality (HR 0.75; p<0.0001) than lower-quality diets (≤11 points). Similar results were found in the studies in patients with vascular diseases.

“Higher-quality diets were associated with lower risks of major CV events and mortality—CV, non-CV and total—in the prospective study and in MI and stroke in the case-control studies.”

“PURE confirms that a diet emphasising fruit, vegetables, nuts, legumes, fish, dairy products and unprocessed meat is the best for CV health and reduces the risk of early death,” says Dr. Mente.

1. Dheghan M, et al. Lancet 2017;390:2050–2062.
2. Miller V, et al. Lancet 2017;390:2037–2049. Read more about the PURE study and the relationship between nutrition and heart disease in the article on page 6 of this issue.


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Notes to editor

About the European Society of Cardiology

The European Society of Cardiology brings together healthcare professionals from more than 150 countries, working to advance cardiovascular medicine and help people lead longer, healthier lives.

About ESC Congress 2018

ESC Congress is the world’s largest and most influential cardiovascular event contributing to global awareness of the latest clinical trials and breakthrough discoveries. ESC Congress 2018 takes place 25 to 29 August at the Messe München in Munich, Germany. Explore the scientific programme