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

• Published in: European journal of clinical nutrition 2002-06, Vol.56 (6), p.512-518
• Main Authors: NESS, A. R, HUGHES, J, ELWOOD, P. C, WHITLEY, E, SMITH, G. D, BURR, M. L
• Format: Article
• Language: English
• Subjects: Animals; Biological and medical sciences; Cardiology. Vascular system; Cerebral infarction; Clinical nutrition; Coronary Disease - diet therapy; Coronary Disease - mortality; Coronary heart disease; Counseling; Diet; Diet Surveys; Dietary Fats - administration & dosage; Dietary fiber; Dietary Fiber - administration & dosage; Diseases of the cardiovascular system; Edible Grain; Fish; Fishes; Follow-Up Studies; Health hazards; Health risks; Heart; Heart attacks; Heart diseases; Humans; Male; Medical sciences; Men; Mortality; Myocardial infarction; Myocardial Infarction - diet therapy; Myocardial Infarction - mortality; Nutrition; Patient Compliance; Questionnaires; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Recurrence; Risk Factors; Seafood; Stroke - diet therapy; Stroke - mortality; Surveys and Questionnaires; Survival; Survival Analysis
• ISSN: 0954-3007; 1476-5640
• DOI: 10.1038/sj.ejcn.1601342

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. Questionnaire survey and mortality follow-up after a trial of dietary advice. Twenty-one hospitals in south Wales and south-west England. Former participants in the Diet and Reinfarction Trial. Current fish intake and cereal fibre intake. All-cause mortality, stroke mortality and coronary mortality. 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). 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.