Habits for a healthy heart : Epidemiological studies on diet and lifestyle factors across diverse subgroups of patients with cardiovascular disease

Samenvatting

Cardiovascular disease (CVD) and coronary heart disease (CHD) are increasing globally, with improved treatments leading to higher survival rates and a growing number of patients living with CHD. However, these patients face elevated risks of recurrent CVD and premature mortality if risk factors are not managed. A healthy diet, alongside medication, exercise, and other lifestyle changes, could play a key role in secondary prevention. This thesis examined the impact of diet and lifestyle factors on long-term health outcomes in CHD patients.---Part I investigated dietary factors such as dairy and potatoes in relation to mortality and diabetes risk. Yogurt consumption was linked to a lower risk of CVD mortality, particularly in women and obese patients, while high-fat milk intake was associated with higher all-cause mortality. Boiled potatoes were found to be neutral for CVD risk but excessive consumption increased all-cause mortality and diabetes risk.---Part II explored lifestyle factors, including alcohol intake, body weight, vitamin D, and physical activity. Light to moderate alcohol consumption was associated with lower mortality risk, though benefits were less clear in women. Overweight CHD patients (BMI ~27 kg/m²) had the lowest mortality risk, while obesity combined with low physical activity increased mortality. Higher vitamin D levels and physical activity independently reduced mortality, with the highest risk observed in patients with low vitamin D and low physical activity levels.---Part III examined dietary patterns and their effects on CVD risk and mortality. A systematic review found that while dietary interventions led to modest insignificant improvements in weight and blood pressure, long-term benefits were uncertain. Higher adherence to the Dutch dietary guidelines was associated with lower CVD and all-cause mortality, especially in women and obese patients.---The thesis concludes that healthy dietary and lifestyle habits are essential in CHD management and that the general dietary guidelines are also applicable to CHD patient. Future guidelines could be personalized based on gender, obesity status, and other factors. Future research should further explore tailored dietary and lifestyle interventions in diverse patient groups.