West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China.
Med-X Center for Informatics, Sichuan University, Chengdu, China.
Am J Clin Nutr. 2021 Nov 8;114(5):1837-1846. doi: 10.1093/ajcn/nqab261.
Both diet and familial factors have a major role in the development of cardiovascular disease (CVD). However, it remains unclear whether familial predisposition to CVD modifies the association between dietary factors and CVD.
The aim was to assess whether the association between diet and CVD varies with familial predisposition to CVD.
In this prospective cohort of the UK Biobank, 462,155 CVD-free participants were included in 2006-2010 and followed for CVD incidence until 2020. Food intake was measured using a short food-frequency questionnaire. Familial predisposition was measured by self-reported family history of CVD and by polygenic risk score (PRS) for CVD based on summary statistics of independent genome-wide association studies.
During a median follow-up of 11.2 y, 46,164 incident CVD cases were identified. A moderately higher risk of CVD was associated with more frequent processed-meat consumption, with an adjusted HR of 1.07 (95% CI: 1.03, 1.11; highest vs. lowest level). Conversely, intakes of fish, cheese, vegetables, and fruit were each associated with reduced CVD risk [HR (95% CI): 0.92 (0.89, 0.96), 0.90 (0.86, 0.94), 0.98 (0.95, 1.00), and 0.93 (0.89, 0.96), respectively]. Stratification analyses by family history of CVD and by PRS for CVD revealed an inverse association between CVD and intakes of fish and cheese, for both subgroups with and without a familial predisposition to CVD. Notably, while the association between processed-meat intake and CVD was restricted to individuals with a familial predisposition to CVD [e.g., HR: 1.11 (1.05, 1.16) and 1.03 (0.97, 1.10) for with and without a family history, respectively, P-interaction < 0.001], the risk reduction of CVD associated with vegetable and fruit intake was only noted among participants without a CVD familial predisposition [e.g., HR for fruit consumption: 1.00 (0.97, 1.03) and 0.91 (0.87, 0.95), respectively, P < 0.001].
Familial factors modify the association between diet and CVD, underscoring the need for personalized dietary guidelines for CVD prevention.
饮食和家族因素在心血管疾病（CVD）的发展中都起着重要作用。然而，家族性 CVD 易感性是否会改变饮食因素与 CVD 之间的关联仍不清楚。
评估饮食与 CVD 之间的关联是否因家族性 CVD 易感性而有所不同。
在英国生物库的这项前瞻性队列研究中，纳入了 2006-2010 年无 CVD 的 462155 名参与者，并随访至 2020 年以确定 CVD 的发病情况。采用短食物频率问卷来测量食物摄入量。家族易感性通过自我报告的 CVD 家族史和 CVD 的基于全基因组关联研究汇总统计数据的多基因风险评分（PRS）来衡量。
在中位随访 11.2 年期间，共确定了 46164 例新发 CVD 病例。更频繁地摄入加工肉类与 CVD 风险增加相关，校正后的 HR 为 1.07（95%CI：1.03，1.11；最高 vs. 最低水平）。相反，摄入鱼、奶酪、蔬菜和水果与降低 CVD 风险相关[HR（95%CI）：0.92（0.89，0.96）、0.90（0.86，0.94）、0.98（0.95，1.00）和 0.93（0.89，0.96）]。根据 CVD 家族史和 CVD 的 PRS 进行分层分析，结果表明，无论是否存在 CVD 的家族易感性，摄入鱼和奶酪均与 CVD 呈负相关。值得注意的是，虽然加工肉类摄入与 CVD 的关联仅见于具有 CVD 家族易感性的个体[例如，有家族史和无家族史时分别为 HR：1.11（1.05，1.16）和 1.03（0.97，1.10），P 交互值<0.001]，但摄入蔬菜和水果与 CVD 风险降低仅见于无 CVD 家族易感性的参与者[例如，水果摄入量的 HR：1.00（0.97，1.03）和 0.91（0.87，0.95），P<0.001]。
家族因素改变了饮食与 CVD 之间的关联，强调了针对 CVD 预防制定个性化饮食指南的必要性。
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