Ultra-processed Food Intake and Long-Term Risk of Cardiovascular Disease Mortality among Patients with Myocardial Infarction: A Prospective Analysis of the Alpha Omega Cohort.

Background: The impact of a diet high in ultra-processed foods (UPFs) on mortality risk in patients with cardiovascular disease (CVD) remains unclear. Objectives: We examined the diet quality of a high UPF diet and its association with risk of total CVD mortality, coronary heart disease (CHD) mortality, and stroke mortality in patients with prior myocardial infarction (MI). Methods: We analyzed data from 4365 patients with a history of MI in the Alpha Omega Cohort (79% males). Dietary intake at baseline was collected using a 203-item food-frequency questionnaire. Diet quality was assessed using the Dutch Healthy Diet Index adapted for patients with CVD (DHD-CVD, range 0-160). UPFs were identified and categorized according to the Nova classification system. Q1 and Q4 of %g/d of UPF represented a low and a high ultra-processed diet, respectively. Hazard ratios (HRs) for CVD, CHD, and stroke mortality were obtained from multivariable Cox regression models. Results: Mean UPF contribution to the diet was 18%g/d (Q1 compared with Q4 = 9%g/d compared with 29%g/d). Compared with Q1, patients in Q4 had higher intakes of total energy and lower intakes of fruit and vegetables. DHD-CVD scores decreased slightly across quartiles (Q1 compared with Q4 = 95 compared with 82). Over a median follow-up of 14 y, 1012 patients died from CVD (659 from CHD, 208 from stroke). Compared with Q1, a high ultra-processed diet was not consistently or significantly associated with CVD and CHD mortality. However, it was associated with a higher risk of stroke mortality (HR Conclusions: In patients withprior MI, a high UPF diet was lower in whole, cardioprotective foods. Our study highlights the adverse association of a high UPF diet with stroke mortality risk among patients who have previously experienced an MI.