(P202) DIETARY INTAKE AND CARDIOVASCULAR OUTCOMES IN PATIENTS WITH CHRONIC VASCULAR DISEASE IN THE COMPASS TRIAL

Background: Patients with coronary artery disease (CAD) are at risk for major adverse cardiovascular events (MACE), and patients with peripheral artery disease (PAD) are at risk for both MACE and major adverse limb events (MALE). There are limited data regarding dietary patterns for recurrent MACE and MALE in CAD and PAD patients.

METHODS AND RESULTS: We analyzed data collected from patients enrolled into the Cardiovascular Outcomes for People Using Anticoagulation Strategies (COMPASS) trial, where diet was assessed by a short food frequency questionnaire (FFQ) at baseline, from which we calculated the modified Alternate Heathy Eating Index (mAHEI). MACE was defined as CV death, myocardial infarction, or stroke. MALE was defined as severe limb ischemia leading to an intervention, which could include acute limb ischemia and major vascular amputation. We report the association between mAHEI, and the incidence of MACE and/or MALE.
We included 26 539 participants with a baseline FFQ, of which 24 119 had CAD and 7163 had PAD. The mean mAHEI score was 23.0 ± 7.7 (out of 70) overall and was similar comparing CAD and PAD patients. Patients with a high mAHEI score (high diet quality) were more likely to be older, have a lower BMI, and were less likely to be current smokers, have hypertension or diabetes. Each 5-point reduction in the mAHEI was associated with a 7% (HR 1.07; 95% CI 1.06-1.08; p=0.001) increase in the composite outcomes of MACE or MALE; and this was stronger in PAD patients (HR 1.11; 95% CI: 1.10-1.12; P=0.002) compared to CAD patients (HR 1.06; 95% 1.05-1.07; P=0.004). The incidence of MACE or MALE was 6.3% in the lowest diet quality quartile compared to 4.2% in the highest quartile over 30 months. In the fully adjusted model, the hazard ratio of a low diet quality (Quartile 1) compared to the highest (Quartile 4) for MACE or MALE was 1.27 (95% CI: 1.08-1.49; p=0.004, Q1 vs Q4). This excess hazard was primarily driven by higher MACE in both the CAD and PAD cohorts. In the CAD cohort the HR for MACE was 1.24 (95% CI 1.04-1.48; p=0.01), and in the PAD cohort the HR was 1.39 (95% CI 1.08-1.79; p=0.01). The estimate in MALE was similarly higher in the low versus high quality quartiles (HR 1.29; 95% CI 0.78-2.14).

Conclusion: Poor diet quality is independently associated with a higher risk recurrent MACE or MALE in patients with chronic CAD and/or PAD.