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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)

Abstract

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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Acknowledgements

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). https://doi.org/10.1038/sj.ejcn.1601342

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Keywords

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

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