NEW YORK (Reuters Health) - In a large U.S. study of men and
women with a heart attack in their past, those who had upped
their fiber intake the most afterwards had the lowest risk of
The pattern held true even after researchers accounted for
medications that lower cholesterol, suggesting it's important
not to rely just on drugs to cut future risks, the authors said.
"There are additional benefits that come from eating
healthy," said Shanshan Li, the study's lead author and an
epidemiologist at the Harvard School of Public Health in Boston.
Diet plays an important role in the development of heart and
artery disease, Li and her coauthors write in the journal BMJ,
but little is known about the difference dietary fiber might
make after a heart attack.
The researchers analyzed data from the Nurses' Health Study
and the Health Professionals Follow-up Study, two long-term
studies that follow the health and risk factors of women and men
across the United States.
At the beginning of the study period the 2,258 women and
1,840 men included in the analysis had survived a first heart
attack and had never had a stroke.
Before and after their heart attacks, all participants had
filled out questionnaires about how often they ate common foods
over the previous year, ranking them from "never" to "six or
more times per day."
Researchers used this information to calculate total fiber
intake and kept track of whether each participant's fiber came
from grains, fruits or vegetables.
Participants were followed for a median of about nine years;
in that time, 336 women and 451 men died from heart
disease-related causes, such as a second heart attack, clogged
arteries in the heart and stroke. A total of 682 women and 451
men died of any cause.
The study also took into account factors that could by
themselves affect mortality, such as weight, exercise and taking
medicines to lower cholesterol.
Li and her team found that for every 10-gram increase in
total fiber intake, the risk of death from any cause dropped by
15 percent. The recommended daily fiber intake for women is 25
grams and 38 grams for men.
The authors point out that only fiber from grains, including
cereals, was linked to lowered risk, and a high intake of this
type of fiber was associated with a 28 percent lower risk of
death compared to people who ate the least fiber.
Notably, the amount of fiber participants ate regularly
before the first heart attack was not related to the odds of
dying later. However, the more a person boosted fiber intake
after the heart attack, the lower their risk of death.
The results line up with what was already known about fiber
intake and heart disease, said Vivian Mo, a cardiologist and
director of the Women's Cardiovascular Center at the University
of Southern California in Los Angeles.
A high-fiber diet has been linked to lower cholesterol
levels, which is associated with a lower risk of heart disease,
Still, the study goes beyond that by showing that eating
more fiber is associated with a lower risk of death - although
it doesn't prove that it's the fiber itself that makes the
difference, she said.
For example, people who eat lots of fiber likely practice
healthy habits and eat an overall healthy diet as compared to
those who don't eat much fiber, she said.
"There are so many differences between people who eat more
or less fiber; it's not just the fiber," Mo told Reuters Health.
But the fact that people who changed their diet the most after a
heart attack had the lowest risk of death is encouraging.
"It's never too late to make a change, such as starting to
eat healthier," Li said.
SOURCE: bit.ly/1mdE91s BMJ, online April 29, 2014.