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Compliance with expert population-based dietary guidelines and lower odds of carotid atherosclerosis in women: the Framingham Nutrition Studies^1,2,3

¹ From the Department of Social and Behavioral Sciences, School of Public Health (BEM, PAQ, and RWK); the Department of Health Sciences, Sargent College of Health and Rehabilitation Sciences (PAQ); the Department of Socio-Medical Sciences (BEM), the Graduate Division of Medical Sciences, School of Medicine (BEM); and the Department of Mathematics (B-HN, MJP, and RBD), Boston University, Boston, MA; the Department of Radiology (JFP) and the Lipid Metabolism Laboratory, US Department of Agriculture Human Nutrition Research Center on Aging (JMO), Tufts University School of Medicine, Boston, MA; and the New England Medical Center, Boston, MA (JFP)

Background: Carotid stenosis, an indicator of subclinical atherosclerosis, predicts future coronary artery disease (CAD) and stroke and provides a noninvasive method to identify candidates for primary prevention. The relation between diet and stenosis is relatively unexplored, particularly in women.

Objective: We evaluated in women the association between nutrient intakes that were consistent with expert population-based dietary guidelines and carotid stenosis.

Design: We used prospective logistic regression analyses to evaluate relations between baseline nutrient intake and the presence of carotid stenosis at 4-y follow-up in 1123 women from the Framingham Offspring-Spouse study, after control for multiple CAD risk factors. We also developed multivariate models that were stratified by compliance with expert population-based dietary guidelines and smoking status.

Results: Baseline nutrient and risk factor profiles differed by women’s compliance and smoking status. Dietary noncompliance and smoking were each associated with odds for stenosis that were 2.5-fold those of dietary compliance and nonsmoking. Odds were highest for dietary noncompliance in combination with smoking (odds ratio: 3.49; 95% CI: 1.67, 7.27).

Conclusions: Nutrient intake consistent with current expert population-based dietary guidelines and smoking abstinence are associated with lower odds of carotid atherosclerosis in women. Unique dietary and risk factor profiles of at-risk women suggest areas for targeted primary CAD prevention.

Key Words: Carotid stenosis • total and saturated fat • dietary cholesterol • smoking • preventive nutrition • coronary artery disease • CAD

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