DASH Score and Subsequent Risk of Coronary Artery Disease: The Findings From Million Veteran Program

Luc Djoussé, Yuk-Lam Ho, Xuan-Mai T Nguyen, David R Gagnon, Peter W F Wilson, Kelly Cho, J Michael Gaziano, VA Million Veteran Program, Ildiko Halasz, Daniel Federman, Jean Beckham, Scott E Sherman, Peruvemba Sriram, Philip S Tsao, Edward J Boyko, Junzhe Xu, Frank Lederle, Louis J Dellitalia, Rachel McArdle, Laurence Kaminsky, Alan C Swann, Mark B Hamner, Hermes J Florez, Prashant Pandya, Gerardo Villarreal, Peter Wilson, Timothy R Morgan, Lori Davis, Robin A Hurley, Laurence Meyer, Sunil K Ahuja, Eric P Konicki, David Cohen, Jack Lichy, Jeffrey Whittle, Kathlyn Sue Haddock, Karl D Straub, John T Callaghan, Samuel M Aguayo, Samir Gupta, Ronald G Washburn, Mary E Oehlert, Adriana M Hung, Agnes Wallbom, Robert Keith, Elif Sonel, Ronald B Schifman, Richard D Childress, Michael F Godschalk, Alan R Shuldiner, Padmashri Rastogi, Salvador Gutierrez, Ronald Fernando, Pran R Iruvanti, Darshana Jhala, Carlos Rosado-Rodriguez, Stephen M Mastorides, John B Harley, Kristin Mattocks, Robert T Striker, Michael Rauchman, John Wells, Zuhair K Ballas, Susan S Woods, Shing Yeh, Nora R Ratcliffe, Jon B Klein, Adam G Golden, Harold M Ginzburg, Satish Sharma, Kris Ann K Oursler, Mary A Whooley, Gretchen Gibson, Luc Djoussé, Yuk-Lam Ho, Xuan-Mai T Nguyen, David R Gagnon, Peter W F Wilson, Kelly Cho, J Michael Gaziano, VA Million Veteran Program, Ildiko Halasz, Daniel Federman, Jean Beckham, Scott E Sherman, Peruvemba Sriram, Philip S Tsao, Edward J Boyko, Junzhe Xu, Frank Lederle, Louis J Dellitalia, Rachel McArdle, Laurence Kaminsky, Alan C Swann, Mark B Hamner, Hermes J Florez, Prashant Pandya, Gerardo Villarreal, Peter Wilson, Timothy R Morgan, Lori Davis, Robin A Hurley, Laurence Meyer, Sunil K Ahuja, Eric P Konicki, David Cohen, Jack Lichy, Jeffrey Whittle, Kathlyn Sue Haddock, Karl D Straub, John T Callaghan, Samuel M Aguayo, Samir Gupta, Ronald G Washburn, Mary E Oehlert, Adriana M Hung, Agnes Wallbom, Robert Keith, Elif Sonel, Ronald B Schifman, Richard D Childress, Michael F Godschalk, Alan R Shuldiner, Padmashri Rastogi, Salvador Gutierrez, Ronald Fernando, Pran R Iruvanti, Darshana Jhala, Carlos Rosado-Rodriguez, Stephen M Mastorides, John B Harley, Kristin Mattocks, Robert T Striker, Michael Rauchman, John Wells, Zuhair K Ballas, Susan S Woods, Shing Yeh, Nora R Ratcliffe, Jon B Klein, Adam G Golden, Harold M Ginzburg, Satish Sharma, Kris Ann K Oursler, Mary A Whooley, Gretchen Gibson

Abstract

Background: While adherence to healthful dietary patterns has been associated with a lower risk of coronary artery disease (CAD) in the general population, limited data are available among US veterans. We tested the hypothesis that adherence to Dietary Approach to Stop Hypertension (DASH) food pattern is associated with a lower risk of developing CAD among veterans.

Methods and results: We analyzed data on 153 802 participants of the Million Veteran Program enrolled between 2011 and 2016. Information on dietary habits was obtained using a food frequency questionnaire at enrollment. We used electronic health records to assess the development of CAD during follow-up. Of the 153 802 veterans who provided information on diet and were free of CAD at baseline, the mean age was 64.0 (SD=11.8) years and 90.4% were men. During a mean follow-up of 2.8 years, 5451 CAD cases occurred. The crude incidence rate of CAD was 14.0, 13.1, 12.6, 12.3, and 11.1 cases per 1000 person-years across consecutive quintiles of Dietary Approach to Stop Hypertension score. Hazard ratios (95% confidence interval) for CAD were 1.0 (ref), 0.91 (0.84-0.99), 0.87 (0.80-0.95), 0.86 (0.79-0.94), and 0.80 (0.73-0.87) from the lowest to highest quintile of Dietary Approach to Stop Hypertension score controlling for age, sex, body mass index, race, smoking, exercise, alcohol intake, and statin use (P linear trend, <0.0001).

Conclusions: Our data are consistent with an inverse association between Dietary Approach to Stop Hypertension diet score and incidence of CAD among US veterans.

Keywords: coronary artery disease; epidemiology; nutrition.

© 2018 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

Figures

Figure 1
Figure 1
Relation between DASH score and incidence of myocardial infarction in the Million Veteran Program (hazard ratio and 95% confidence interval band); P for linearity <0.0001. CAD indicates coronary artery disease; DASH, dietary approach to stop hypertension.

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Source: PubMed

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