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The long-term effect of dietary advice in men with coronary disease: follow-up of the Diet and Reinfarction trial (DART)


Objective: To assess the long-term effect of dietary advice on diet and mortality after a randomised trial of men with a recent history of myocardial infarction.

Design: Questionnaire survey and mortality follow-up after a trial of dietary advice.

Setting: Twenty-one hospitals in south Wales and south-west England.

Subjects: Former participants in the Diet and Reinfarction Trial.

Main outcome measures: Current fish intake and cereal fibre intake. All-cause mortality, stroke mortality and coronary mortality.

Results: By February 2000, after 21147 person years of follow-up, 1083 (53%) of the men had died. Completed questionnaires were obtained from 879 (85%) of the 1030 men alive at the beginning of 1999. Relative increases in fish and fibre intake were still present at 10 y but were much smaller. The early reduction in all-cause mortality observed in those given fish advice (unadjusted hazard 0.70 (95% CI 0.54, 0.92)) was followed by an increased risk over the next 3 y (unadjusted hazard 1.31 (95% CI 1.01, 1.70). Fat and fibre advice had no clear effect on coronary or all-cause mortality. The risk of stroke death was increased in the fat advice group–the overall unadjusted hazard was 2.03 (95% CI 1.14, 3.63).

Conclusions: In this follow-up of a trial of intensive dietary advice following myocardial infarction we did not observe any substantial long-term survival benefit. Further trials of fish and fibre advice are feasible and necessary to clarify the role of these foods in coronary disease.

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  • Alberts DS, Martinez ME, Roe DJ, Guillen-Rodriguez JM, Marshall JR, van Leeuwen B, Reid ME, Ritenbaugh C, Vargas PA, Bhattacharyya AB, Earnest DL, Sampliner RE . 2000 The Phoenix Colon Cancer Prevention Physicians Lack of effect of a high-fibre cereal supplement on the recurrence of colorectal adenomas New Engl. J. Med. 342: 1156–1162

    CAS  Article  Google Scholar 

  • Anderson JW, Hanna TJ . 1999 Whole grains and protection against coronary heart disease: what are the active components and mechanisms? Am. J. Clin. Nutr. 70: 307–308

    CAS  Article  Google Scholar 

  • Billman GE, Kang JX, Leaf A . 1997 Prevention of ischaemia-induced cardiac sudden death by n-3 polyunsaturated fatty acids in dogs Lipids 32: 1161–1168

    CAS  Article  Google Scholar 

  • Bonithon-Kopp C, Kronborg O, Giacosa A, Räth U, Faivre J . 2000 the European Cancer Prevention Organisation Study Group Calcium and fibre supplementation in prevention of colorectal adenoma recurrence: a randomised intervention trial Lancet 356: 1300–1306

    CAS  Article  Google Scholar 

  • Burr ML, Fehily AM, Gilbert JF, Rogers S, Holliday RM, Sweetnam PM, Elwood PC, Deadman NM . 1989a Effects of changes in fat, fish, and fibre intakes on death and myocardial reinfarction: diet and reinfarction trial (DART) Lancet ii: 757–761

    Article  Google Scholar 

  • Burr ML, Fehily AM, Rogers S, Welsby E, King S, Sandham S . 1989b Diet and reinfarction trial (DART): design, recruitment, and compliance Eur. Heart J. 10: 558–567

    CAS  Article  Google Scholar 

  • Fehily AM, Vaughan-Williams E, Shiels K, Horner M, Bingham G, Burr ML, Holiday RM . 1989 The effect of dietary advice on nutrient intakes: evidence from the diet and reinfarction trial (DART) J. Hum. Nutr. Diet. 2: 225–235

    Article  Google Scholar 

  • Gillman MW, Cupples LA, Millen BE, Ellison RC, Wolf PA . 1997 Inverse association of dietary fat with development of ischemic stroke in men J.A.M.A. 278: 2145–2150

    CAS  Article  Google Scholar 

  • GISSI-Prevenzione Investigators. 1999 Dietary supplementation with n-3 polyunsaturated fatty acids and vitamin E after myocardial infarction: results of the GISSI-Prevenzione trial Lancet 354: 447–455

  • Hooper L, Summerbell CD, Higgin JPT, Thompson RL, Capps NE, Smith D, Riemersma G, Rudolph A, Ebrahim S . 2001 Dietary fat intake and prevention of cardiovascular disease: systematic review Br. Med. J. 322: 757–763

    CAS  Article  Google Scholar 

  • Kimura N . 1983 Changing patterns of coronary heart disease, stroke, and nutrient intake in Japan Prev. Med. 12: 222–227

    CAS  Article  Google Scholar 

  • Kinsella JE, Lokesh B, Stone RA . 1990 Dietary n-3 polyunsaturated fatty acids and amelioration of cardiovascular disease: possible mechanisms Am. J. Clin. Nutr. 52: 1–28

    CAS  Article  Google Scholar 

  • Marckmann P, Gronbæk M . 2000 Fish consumption and coronary heart disease mortality A systematic review of prospective cohort studies Eur. J. Clin. Nutr. 53: 585–590

    Article  Google Scholar 

  • McGee D, Reed DM, Stemmerman G, Rhoads G, Yano K, Feinleib M . 1985 The relationship of dietary fat and cholesterol to mortality in 10 y: the Honolulu heart program Int. J. Epidemiol. 14: 97–105

    CAS  Article  Google Scholar 

  • Stata Corporation. 1997 Stata (Statistics/Data analysis) Version 5.0 Texas: Stata Corporation

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The original trial was carried out by the MRC Epidemiology Unit (South Wales). The current work is supported by a small grant from the Wales Office of Research and Development for Health and Social Care and by a grant from the British Heart Foundation.

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Correspondence to AR Ness.

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Ness, A., Hughes, J., Elwood, P. et al. The long-term effect of dietary advice in men with coronary disease: follow-up of the Diet and Reinfarction trial (DART). Eur J Clin Nutr 56, 512–518 (2002).

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  • fish
  • fibre
  • fat
  • dietary advice
  • randomised controlled trial
  • all-cause mortality
  • coronary heart disease
  • stroke

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