Summary:
Diets rich in vegetables, fruits, whole grains, and fibre are consistently linked to a lower risk of cardiovascular disease and death. Cardiovascular disease remains the leading cause of death and disability worldwide. Research shows that distinguishing anti-inflammatory foods (such as fruits, vegetables, nuts, whole grains, low-fat dairy, coffee, tea, and olive oil) from pro-inflammatory foods (such as red and processed meats, sugar-sweetened drinks, and fried foods) predicts lower risk of mortality, aneurysm, and heart failure. However, the relationship between diet and coronary plaque characteristics, a key risk factor for cardiovascular disease, has not been widely studied. This study investigated whether an anti-inflammatory diet was associated with coronary plaque and cardiovascular risk factors in a large, population-based Swedish cohort. The hypothesis was that diets low in fibre and high in red and processed meat would be linked to adverse plaque features. Participants had no clinical cardiovascular disease at baseline. A dietary index was calculated and used to group participants. Coronary atherosclerosis was assessed, including the presence of plaque and its characteristics. Those with the least healthy diets were generally younger, more often men, had higher levels of inflammation, and more cardiovascular risk factors. They also had more plaque (44.3% vs 36.3%), more severe narrowing (6.0% vs 3.7%), and more high-risk plaques (1.5% vs 0.9%) compared with those with the healthiest diets. Even after adjusting for age, sex, and smoking, a less healthy diet remained linked to high-risk plaque. In conclusion, diets low in fibre and high in red and processed meat were associated with more advanced and high-risk coronary plaque features.
Abstract:
Aims: Diet is a determinant of cardiovascular diseases (CVD) with coronary disease as predominant cause of pre-mature death. To analyse how diet was associated with coronary atherosclerosis, including plaque features. Methods and results: The cross-sectional population-based study using data from the Swedish CArdioPulmonary BioImage Study (SCAPIS) included 24 079 adults aged 50–64 years, recruited in 2013 to 2018 who were free of clinical cardiovascular disease. The recruitment and comprehensive examinations were conducted at six locations in Sweden. A dietary index (DI) based on a previously published anti-inflammatory DI including high proportion of plant-based foods, and low in red or processed meat and sugar-sweetened beverages was constructed. The reference group was within lowest DI tertile. Coronary atherosclerosis assessed by coronary computed tomography angiography, including any-, significant-, and adverse or high-risk coronary plaque, which is non-calcified with a significant stenosis ≥50%. Lowest, compared to highest DI tertile was associated with younger age, more often men (62.2% vs. 32.9%), higher high-sensitive C-reactive protein, more cardiometabolic risk and smokers, higher alcohol-, and higher energy-intake. In the highest and lowest tertile, coronary plaques were present in 36.3% and 44.3%, respectively, stenosis ≥ 50% in 3.7% and 6.0%. Non-calcified coronary plaques with stenosis ≥50% were present in 0.9% and 1.5% in highest and lowest tertiles. In multivariable analyses, the lowest tertile of DI was associated with high-risk plaque features after adjusting for age, sex, smoking, with waist circumference, triglycerides (TGs), and hypertension as possible mediators. Conclusion: A low-fibre diet with high red meat content was associated with high-risk plaques features, increased coronary calcification and significant stenosis. Waist circumference, TGs, and hypertension emerged as potential mediators of these associations, underscoring the role of metabolic and hemodynamic factors in the dietary impact on coronary atherosclerosis. Our findings strengthen the importance of cardioprotective dietary recommendations.
Article Publication Date: 16/06/2025
DOI: 10.1093/cvr/cvaf088
