DASH diet reduces heart attack risk in short and long term

Picking the right heart-healthy diet can improve patient health by reducing risks of heart attacks and strokes.

The DASH diet – for Dietary Approaches to Stop Hypertension – had short- and long-term benefits for women and Black adults, compared to eating a traditional western diet that is low in fruits and vegetables and high in fat and sodium. The findings from Beth Israel Deaconess Medical Center (BIDMC) were published in the American Journal of Cardiology.

"While physicians and patients rely on the extensive data available when choosing appropriate pharmacologic therapy to prevent atherosclerotic cardiovascular disease, there's limited evidence to inform expectations for risk reductions from established lifestyle interventions," corresponding author Stephen P. Juraschek, MD, PhD, said in a news release. Juraschek is a clinician-researcher in the Department of Medicine at BIDMC.

"Our study suggests that the benefits associated with these diets may vary by sex and race,” Juraschek said. “While a diet rich in fruits and vegetables produced reductions in risk for woman and Black participants, the effect with the DASH diet was twice as large in women and four times as large in Black adults."

Three diets

The researchers acquired data from 459 adults aged 22 to 75 who participated in the original DASH diet study from 1994 to 1996. Participants were roughly half women and half Black, and were randomized to try one of three diets:

• A control diet high in total fat, saturated fat, and cholesterol
• A fruit and vegetable diet with more produce, but no other significant changes
• The DASH diet, with more fruit and vegetables and emphasizing more whole grains, lean proteins, nuts, and low-fat dairy products, while reducing fat, saturated fat, cholesterol, and sugar

The results suggested using diet to achieve a 10% reduction in risk over an eight-week period, along with a risk reduction of about 10% for atherosclerotic cardiovascular disease over 10 years. The DASH diet cut 10-year risk by almost 13% for women, compared to 6% for men, and by almost 14% for Black adults, compared to 3% for non-Black adults, according to a news release.

“The findings could have major implications for clinical practitioners and policy makers alike," first author Sun Young Jeong, MD, MPH, said in the news release. Jeong is an internal medicine resident at BIDMC.

"Cardiovascular disease is the leading cause of death in women and hypertension is also more strongly linked with heart failure and death in women than men. We also know women are less likely to receive risk factor modification therapies, such as statins, so our finding that DASH may be more efficacious among women are relevant for lifestyle counseling in this group," Jeong said.

Meanwhile, access to healthy foods – or lack of access – has been a major focus of policy efforts to encourage Black adults to eat more fruits and vegetables, Jurascheck said.

"Our study suggests that the DASH dietary pattern may offer Black adults more prevention benefits than the emphasis on fruits and vegetables alone,” Jurascheck said. “This is particularly relevant as dietary pattern has been identified as one of the most important mediators of hypertension risk among Black adults."

Eating for heart health

It appeared the results affirmed a study presented in September at the American Heart Association’s (AHA) Hypertension Scientific Sessions 2022. That analysis of the DASH diet estimated widespread adoption of the DASH diet would prevent 15,000 deaths of men and 11,000 deaths among women over the next 10 years.

The research team estimated that 8.8 million U.S. adults, ages 35-64, have untreated stage 1 hypertension. That is based on the AHA and American College of Cardiology High Blood Pressure Guideline of stage 1 hypertension as having systolic, or top number, level of 130 to 139 mm Hg or having a diastolic, or bottom number, measure of 80 to 89 mm Hg.

For those patients, physicians would recommend lifestyle changes, such as physical activity, sustained weight loss, moderating alcohol intake and adoption of the DASH diet.

“Nearly nine million young and middle-aged adults with untreated stage 1 hypertension represent a significant, impending burden for health care systems,” co-lead Kendra D. Sims, PhD, MPH, said in a news release. Sims is a postdoctoral fellow at the University of California, San Francisco. “Our results provide strong evidence that large-scale, healthy behavior modifications may prevent future heart disease, related complications and excess health care costs.”