Southern diet could be deadly for people with heart disease

July 12, 2018, American Heart Association
Credit: CC0 Public Domain

People with a history of heart disease who eat a traditional Southern diet are more likely to die than those who follow a Mediterranean dietary pattern, according to new research.

The large-scale study, published Thursday in the Journal of the American Heart Association, adds to the growing body of evidence on and its association with dietary patterns from different parts of the world.

Researchers defined the U.S. Southern as high in added fats, fried food, eggs, processed meats and sugar-sweetened beverages. By contrast, the Mediterranean diet was defined as high in vegetables, fruits, fish, whole grains and legumes, and low in meat and dairy.

The study is among the first to zero in on people who already had a history of coronary disease, such as a previous heart attack or surgery. Researchers examined data from 3,562 white and African-American men and women ages 45 and older living in different parts of the United States. Participants were first given an exam and dietary assessment, and then called every six months to ask about new coronary heart disease events.

Seven years later, 581 people had experienced a second coronary heart disease event, and 1,098 people had died from a variety of causes. After looking closely at an assortment of dietary patterns, researchers found a clear association between death and people who ate a Southern diet.

"The greater someone adheres to the Southern dietary pattern, the higher the risk of all-cause mortality," said James Shikany, the study's lead author and a nutritional epidemiologist at the University of Alabama at Birmingham's Division of Preventive Medicine. "But with the Mediterranean diet, the greater they adhere, the lower the risk of recurrent and all-cause mortality."

The study was a follow-up to research published in 2015 that found a higher risk of acute heart attack or heart-related death among participants without a history of heart disease at the start of the study.

Shikany said it's important to note that the research – both the new study and the 2015 study – looked at , not specific foods. "We do not know which individual components of the Southern pattern confer the most risk," he said.

Still, he noted, these latest results should be a wake-up call for anyone with heart disease who eats a traditional Southern diet.

"We believe it is prudent to add more fruits and vegetables, and switch to more unsaturated fats, such as olive oil, as opposed to butter," he said.

Marie-Pierre St-Onge, associate professor of nutritional medicine at Columbia University in New York, called it "a unique study that shows how important it is to consume a healthy diet." Yet she also called for future studies to examine how people with heart fare after they improve their diet.

"A cardiovascular event is a scary thing, and it can be a high motivator for people to eat more healthfully and exercise more," said St-Onge, who wasn't involved in the study. "I'd like to know how making lifestyle changes after the first event might prevent secondary events and death."

Shikany said he hopes the study underscores the importance for doctors to counsel patients on nutrition and offer suggestions for changing their diet. He also recommends patients work with a registered dietitian to plot out concrete ways to eat healthier.

Federal dietary guidelines recommend a healthy eating pattern that features fruits, vegetables, whole grains, legumes, nuts, seeds and fish, and that limits added sugars, sodium and saturated fats.

The key for all health care providers, Shikany said, is taking a slow-and-steady approach to get patients to improve their diets for the long-run.

"Instead of eating processed meats every day, perhaps recommend they start out by cutting that down to twice a week," he said. "If you recommend a radical change, all at once, people … are less likely to make changes."

Explore further: Vegetarian and Mediterranean diet may be equally effective in preventing heart disease

More information: James M. Shikany et al. Dietary Patterns and Mediterranean Diet Score and Hazard of Recurrent Coronary Heart Disease Events and All‐Cause Mortality in the REGARDS Study, Journal of the American Heart Association (2018). DOI: 10.1161/JAHA.117.008078

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