Background Population-based studies generally show neutral associations between dairy consumption and ischemic heart disease (IHD) mortality, whereas weak inverse associations were found for cardiovascular disease (CVD) and stroke mortality. Whether dairy consumption affects long-term survival after myocardial infarction (MI) is unknown. Objectives We studied types of dairy and long-term mortality risk in drug-treated post-MI patients. Methods We included 4365 Dutch patients from the Alpha Omega Cohort aged 60–80 y (21% women) with an MI ≤10 y before enrollment. Dietary data were collected at baseline (2002–2006) using a 203-item FFQ and patients were followed for cause-specific mortality through December 2018. HRs of CVD, IHD, stroke, and all-cause mortality for types of dairy were obtained from Cox models, adjusting for age, sex, energy intake, physical activity, smoking, alcohol intake, diabetes, obesity, and dietary factors. Results Most patients were Dutch, 24% were obese, 20% had diabetes, and 97% used cardiovascular medication. Median intakes were 39 g/d for plain yogurt, 88 g/d for total nonfermented milk, and 17 g/d for hard cheeses. Of the cohort, 10% consumed high-fat milk. During ∼12 y of follow-up (48,473 person-years) 2035 deaths occurred, including 903 from CVD, 558 from IHD, and 170 from stroke. Yogurt was linearly inversely associated with CVD mortality (HR: 0.96; 95% CI: 0.93, 0.99; per 25 g/d) and nonlinearly inversely associated with all-cause mortality. Milk was not associated with any of the outcomes (HRs: ∼1.0 per 100 g/d), except for a higher mortality risk in high-fat milk consumers (HR: 1.30; 95% CI: 1.13, 1.49). Other dairy groups were not associated with mortality risk. Conclusions In Dutch post-MI patients, yogurt consumption was inversely associated with CVD mortality and all-cause mortality. Associations for milk and other dairy products were neutral or inconsistent. This trial was registered at clinicaltrials.gov as NCT03192410.

Background Population-based studies generally show J-shaped associations between alcohol intake and mortality from cardiovascular diseases (CVD). Little is known about alcohol and long-term mortality risk after myocardial infarction (MI). Objective We examined alcohol intake in relation to all-cause, CVD and ischemic heart disease (IHD) mortality in Dutch post-MI patients of the Alpha Omega Cohort. Design The analysis comprised 4,365 patients (60-80 y, 79% male) with an MI ≤10 y before study enrolment. We used a 203-item food-frequency questionnaire to assess alcohol (total ethanol) and dietary intakes over the past month. Patients were classified as non-drinkers (0 g/d, n = 956) or very light (>0-2 g/d, n = 385), light (M: >2-10, F: >2-5 g/d, n = 1125), moderate (M: >10-30, F: >5-15 g/d, n = 1207) or heavy drinkers (M: >30, F: >15 g/d, n = 692). Hazard ratios (HRs) of mortality for alcohol intake were obtained from Cox models, adjusting for age, sex, education, smoking, BMI, physical activity and dietary factors. Results Alcohol was consumed by 83% of males and 61% of females. During ∼12 y of follow-up, 2,035 deaths occurred of which 903 from CVD and 558 from IHD. Compared to the (combined) reference group of non-drinkers and very light drinkers, HRs (95% CI) for all-cause mortality were 0.87 (0.78, 0.98), 0.85 (0.75, 0.96) and 0.91 (0.79, 1.04) in consecutive drinking categories. For CVD mortality, corresponding HRs were 0.80 (0.67, 0.96), 0.82 (0.69, 0.98) and 0.87 (0.70, 1.08). Findings for IHD mortality were similar. HRs did not materially change when non-drinkers or very light drinkers were taken as the reference, or after exclusion of former drinkers or patients with diabetes or poor/moderate self-rated health. Conclusion Light and moderate alcohol intake were inversely associated with mortality risk in stable post-MI patients. These observational findings should be cautiously interpreted in light of the total evidence on alcohol and health. Registration: The Alpha Omega Cohort is registered at Clinicaltrials.gov as NCT03192410.

BackgroundHigher potato intake, especially French fries, was unfavorably associated with cardiometabolic endpoints in population-based studies. Little is known about this in patients with ischemic heart disease (IHD).ObjectiveTotal and boiled potatoes and French fries intake were examined in relation to cardiovascular disease (CVD) mortality, all-cause mortality, and type 2 diabetes mellitus (T2DM) risk in Dutch post-myocardial infarction (MI) patients of the Alpha Omega Cohort.MethodsWe analyzed 3,401 patients (60–80 years, 78% male), free from T2DM at baseline, with an MI ≤ 10 years before enrolment. Diet was assessed at baseline (2002–2006) using a 203-item validated Food Frequency Questionnaire (FFQ) that includes potato preparation methods. Cause-specific mortality was monitored through December 2018, and T2DM incidence (self-reported physician diagnosis and/or prescribed anti-diabetes medication) was monitored during the first 40 months of follow-up. Multivariable Cox models were used to obtain hazard ratios (HRs) for fatal endpoints and incident T2DM in tertiles of potato intake.ResultsPatients had a median total potato intake (mainly boiled) of 111 g/d, 96% consumed >1 serving (200 g) per week. French fries were consumed by 48% of the patients (median of 6 g/d among consumers). During >12 years of follow-up (38,987 person-years), 1,476 deaths occurred of which 641 were from CVD, 394 were from IHD, and 119 were from a stroke. Total and boiled potatoes were not associated with CVD mortality, but a higher risk of all-cause mortality was observed (HR: 1.07; 95% CI: 1.01, 1.14; per 50 g/d). Potato consumption tended to be positively associated with incident T2DM (186 cases; HR: 1.11, 95% CI: 0.94, 1.32; per 50 g/d). Results for French fries were inconsistent for all outcomes.ConclusionIn Dutch post-MI patients, potatoes (mainly boiled) were not associated with CVD mortality but possibly adversely associated with all-cause mortality and T2DM risk. These findings warrant confirmation in other IHD patient cohorts. The Alpha Omega Cohort is registered at ClinicalTrials.gov as NCT03192410.

Background: Circulating odd-chain fatty acids (OCFAs) 15:0 and 17:0, potential biomarkers of dairy (fat) intake, have been associated with cardiometabolic outcomes in population-based studies. Whether circulating OCFAs are related to mortality risk in patients who experienced a myocardial infarction (MI) is not yet clear. Methods: We included 4,741 Dutch patients aged 60-80 y (78% males) from the Alpha Omega Cohort, who experienced a myocardial infarction (MI) up to 10 years prior to study enrolment. At baseline (2002-2006), data were obtained on risk factors for cardiovascular disease (CVD), medication, lifestyle factors and dietary intakes (203-item FFQ). Fatty acids in serum cholesteryl esters (CE) were assessed using gas chromatography. Multivariable Cox models were used to obtain hazard ratios (HRs) and 95% confidence intervals (CI) for total and CVD mortality in relation to 15:0 and 17:0 in CE (per 10 th to 90 th percentile range, P 10-90 ). HRs were adjusted for age, sex, education, BMI, physical activity, diabetes, other CVD risk factors, medication, circulating linoleic acid, circulating EPA+DHA, and dietary factors. Missing data imputation was performed for confounders. Findings: Most patients used cardiovascular drugs (statins: 85%) and 979 patients (21%) had diabetes. During a median follow-up period of 12.4 years (total of 52,625 person-years), 2,233 patients died, of whom 984 from CVD. Circulating levels (% of total fatty acids) were low for 15:0 (median: 0.16; P 10-90 : 0.11-0.21) and 17:0 (median: 0.08; P 10-90 : 0.00-0.11). For 15:0, age and sex adjusted HRs per P 10-90 were 0.88 (95% CI: 0.81-0.95; P =0.001) for total mortality and 0.94 (0.83-1.06) for CVD mortality. In the most adjusted model, HRs for 15:0 were 0.92 (0.84-1.00; P =0.042) and 0.97 (0.85-1.11), respectively. For 17:0, HRs were 0.94 (0.85-1.05) for total mortality and 0.97 (0.83-1.13) for CVD mortality. Stratified analyses by sex showed inverse associations for 15:0 mainly in men (total mortality: HR of 0.90 [0.82-1.00]; P =0.047). For 17:0, inverse but non-significant associations were mainly observed in women (total mortality: HR of 0.85 [0.68-1.05]). Associations for 17:0, but not for 15:0, were stronger in diabetic patients (total mortality: HR of 0.78 [0.64-0.96]; P =0.019). Conclusions: Higher circulating OCFA levels may be related to a lower mortality risk after MI, which needs confirmation in other cohorts of CVD patients. The role of dairy fat intake in this relationship warrants further investigation.

Introduction: Population-based studies showed beneficial associations between (low-fat) dairy products and kidney function. Kidney function declines with age, which is accelerated after myocardial infarction (MI). Little is known about dairy consumption and kidney function in MI patients. Hypothesis: Dairy intake may slow down kidney function decline after MI. Methods: We analysed 2,247 Dutch post-MI patients (60-80 years, 81% men) from the Alpha Omega Cohort. Dietary intakes, including types of dairy, were assessed at baseline (2002-2006) using a validated 203-item food frequency questionnaire. Glomerular filtration rate was estimated at baseline and after ~40 months, using the Chronic Kidney Disease (CKD) Epidemiology Collaboration equations for serum cystatin C alone (eGFR cysC , in ml/min per 1.73m 2 ). Associations between dairy intake and annual eGFR cysC change were obtained using multivariable linear regression models, adjusting for age, sex, lifestyle and dietary factors. Betas (β), with 95% confidence intervals (95% CI), represent additional eGFR cysC changes on top of annual decline, per increment in dairy intake. Results: At baseline, 22% was obese, 18% had diabetes and 15% had CKD (eGFR cysC <60). Median dairy intakes were 70 g/day for milk (62% consumed low-fat milk), 41 g/day for yogurt and 17 g/day for hard cheeses. The mean ± SD eGFR cysC at baseline was 82 ± 19, which on average declined by 3.42 ± 11.04, corresponding to an annual decline of 0.99 ± 3.21. Total milk consumption was not associated with annual eGFR cysC change in the multivariable model (β: 0.01 per 100 g/day, 95% CI: -0.08;0.10; Figure 1). Associations for hard cheeses (per 10 g/day) and yogurt (per 25 g/day) with eGFR cysC decline were also weak and non-significant. Sensitivity analyses in non-diabetic (n=1,843) or non-CKD patients (n=1,910) yielded similar results (Figure 1). Conclusions: Milk, hard cheeses and yogurt consumption were not associated with eGFR cysC decline in Dutch post-MI patients.