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Relation of diet to cardiovascular disease risk factors in subjects with cardiovascular disease in Australia and New Zealand: analysis of the Long-Term Intervention with Pravastatin in Ischaemic Disease trial^1,2,3

¹ From the Baker Heart Research Institute, Melbourne, Australia (PJN); the CSIRO Division of Health Science & Nutrition, Adelaide, Australia (KB); the Department of Medicine, University of Queensland, Brisbane, Australia (DMC); the National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, Australia (RJS, KM, AK, and CP); the Cardiology Department, Auckland City Hospital, Auckland, New Zealand (HDW); and the Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia (AMT)

Background: Comparisons of the relation of diet with coronary heart disease (CHD) between countries with similar socioeconomic environments have been few. Patients in Australia and New Zealand (n = 9014) who participated in a large secondary prevention trial had significantly different CHD mortality rates.

Objective: The objective of this study was to ascertain the effects of nutrient consumption on cardiovascular disease risk in patients from the 2 countries.

Design: Nutrient consumption patterns were surveyed in a subgroup of 1077 patients on 3 occasions over 4 y during an intervention trial with a statin.

Results: Within the entire cohort of 9014 patients, the New Zealanders had significantly (40%) more cardiovascular deaths than did the Australians. In the subgroup of 1077 patients, the New Zealanders were found at entry to have eaten significantly more total (69.34 ± 12.35 compared with 66.45 ± 12.9 g/d) and saturated (26.23 ± 8.41 compared with 24.37 ± 7.36 g/d) fat (P < 0.001 for each) and to have significantly (4%) higher concentrations of LDL cholesterol (3.96 ± 0.74 compared with 3.8 ± 0.76 mmol/L; P < 0.001) than did the Australians. At baseline, patients with previous coronary artery bypass grafting had diets that were significantly different from those of patients without previous coronary artery bypass grafting. Relations between nutrients and plasma lipids confirmed the direct effects of saturated fatty acids on LDL cholesterol and of alcohol on plasma triacylglycerol and HDL cholesterol. Dietary counseling throughout the trial led to significant improvements in compliance with guidelines. However, neither the baseline nor the improved 1-y nutrient intakes predicted future changes in cardiovascular events.

Conclusion: Differences in CHD mortality and in LDL-cholesterol concentrations between 2 populations with similar socioeconomic and cultural backgrounds were consistent with the amounts and types of fats eaten.

Key Words: Total fat • saturated fat • cardiovascular events • LDL cholesterol • population comparison • clinical trial