Bonekamp Nadia E, Cruijsen Esther, Visseren Frank Lj, van der Schouw Yvonne T, Geleijnse Johanna M, Koopal Charlotte
Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
Division of Human Nutrition and Health, Wageningen University, Wageningen, the Netherlands.
Clin Nutr. 2023 Aug;42(8):1418-1426. doi: 10.1016/j.clnu.2023.06.033. Epub 2023 Jul 5.
BACKGROUND & AIMS: The Dietary Approaches to Stop Hypertension (DASH) diet has been shown to effectively reduce blood pressure and body weight, but its effectiveness for reducing (cardiovascular) mortality rates has never been assessed in a clinical trial. Causal effects of dietary interventions are difficult to measure, due to practical limitations of randomized controlled diet trials. Target trial emulation can be used to improve causal inference in observational data. The aim of this study was to emulate a target trial assessing the relationship between compliance with the DASH diet and cardiovascular and all-cause mortality risk in patients with established CVD.
Using data from the Alpha Omega Cohort, we emulated a DASH diet trial in patients with a history of myocardial infarction (MI). Inverse probability of treatment weighting (IPTW) was used to balance confounders over DASH-compliant and non-DASH-compliant participants. Hazard ratios (HRs) were estimated with IPT-weighted Cox models.
Of 4365 patients (79% male, median age 69 years, >80% treated with lipid- and blood pressure-lowering medication), 598 were classified as DASH-compliant (compliance score ≥5 out of 9). During a median follow-up of 12.4 years, 2035 deaths occurred of which 903 (44%) were of cardiovascular origin. DASH compliance was not associated with all-cause mortality (HR 0.92, 95%CI 0.0.80-1.06) and cardiovascular mortality (HR 0.90, 95%CI 0.72-1.11).
In an emulated target trial on the DASH diet in the Alpha Omega cohort no relation was found between DASH compliance and risk of all-cause and cardiovascular mortality in patients with a history of MI. The DASH diet's effects may have been modified in this population by concomitant use of blood pressure-lowering medications.
已证实终止高血压膳食疗法（DASH饮食）可有效降低血压和体重，但尚未在临床试验中评估其对降低（心血管）死亡率的有效性。由于随机对照饮食试验存在实际限制，膳食干预的因果效应难以衡量。目标试验模拟可用于改善观察性数据中的因果推断。本研究的目的是模拟一项目标试验，评估已确诊心血管疾病（CVD）患者对DASH饮食的依从性与心血管及全因死亡风险之间的关系。
利用阿尔法欧米伽队列的数据，我们在有心肌梗死（MI）病史的患者中模拟了一项DASH饮食试验。采用治疗权重逆概率（IPTW）来平衡DASH饮食依从组和非DASH饮食依从组之间的混杂因素。使用IPTW加权Cox模型估计风险比（HRs）。
在4365名患者中（79%为男性，中位年龄69岁，>80%接受降脂和降压药物治疗），598名被归类为DASH饮食依从者（依从性评分在9分制中≥5分）。在中位随访12.4年期间，发生了2035例死亡，其中903例（44%）为心血管原因导致。DASH饮食依从性与全因死亡率（HR 0.92，95%CI 0.80 - 1.06）和心血管死亡率（HR 0.90，95%CI 0.72 - 1.11）均无关。
在阿尔法欧米伽队列中关于DASH饮食的模拟目标试验中，未发现有MI病史患者的DASH饮食依从性与全因及心血管死亡率风险之间存在关联。在该人群中，DASH饮食的效果可能已因同时使用降压药物而改变。
