Elsevier

Nutrition

Volume 29, Issue 4, April 2013, Pages 611-618
Nutrition

Review
Effects of Dietary Approaches to Stop Hypertension (DASH)-style diet on fatal or nonfatal cardiovascular diseases—Incidence: A systematic review and meta-analysis on observational prospective studies

https://doi.org/10.1016/j.nut.2012.12.018Get rights and content

Abstract

Background

Cardiovascular diseases (CVDs) are a group of disorders affecting heart and blood vessels. However, protective roles are proposed for Dietary Approaches to Stop Hypertension (DASH)-style diets.

Objective

The aim of this review was to summarize and if possible quantify the longitudinal effects of a DASH-style diet on the incidence of CVDs.

Design

Pubmed, ISI web of science, and EMBASE were searched and cohort studies that examined the DASH-style diet in relation to CVDs, coronary heart disease (CHD), stroke, and heart failure (HF) were selected. Cohort studies which included participants with specific CVD risk factors like diabetes mellitus, metabolic syndrome, obesity or hypertension were excluded from review. Relative risks (RRs) that were reported for fully adjusted models and their confidence intervals were extracted for meta-analysis.

Results

Regarding the adherence to the DASH diet and the incidence of CVDs, stroke, CHD, and HF, only 6 studies met our criteria to be included in this systematic review. Meta-analysis showed that imitating a DASH-like diet can significantly reduce CVDs (RR = 0.80; 95% confidence interval [CI], 0.74–0.86; P < 0.001), CHD (RR = 0.79; 95% CI, 0.71–0.88; P < 0.001), stroke (RR = 0.81, 95% CI, 0.72–0.92; P < 0.001), and HF (RR= 0.71, 95% CI, 0.58–0.88; P < 0.001) risk. A linear and negative association was obtained between DASH-style diet concordance and all CVDs, as well.

Conclusion

In conclusion, our results showed that a DASH-like diet can significantly protect against CVDs, CHD, stroke, and HF risk by 20%, 21%, 19% and 29%, respectively. Furthermore, there is a significant reverse linear association between DASH diet consumption and CVDs, CHD, stroke, and HF risk.

Introduction

Cardiovascular diseases (CVDs) are a group of disorders affecting the heart and blood vessels; they are the leading cause of death worldwide. Based on World Health Organization (WHO) reports, 17.3 million people (about 30% of global death) died from CVDs in 2008, of these deaths, 7.3 million and 6.2 million were reported to be due to coronary heart disease (CHD) and stroke, the two major subclasses of CVDs, respectively. Heart failure (HF) also is another highly prevalent group of CVDs with a current prevalence of more than 5.8 million in the United States and in excess of 23 million, worldwide [1], [2]. Approximately 80% of CVDs are seen in low- and middle-income countries, and they occur almost equally in both genders [3]. Behavioral risk factors are considered to be responsible for about 80% of CHD and cerebrovascular diseases. Based on evidence, unhealthy diet, physical inactivity, tobacco use, and harmful alcohol consumption are major behavioral risk factors for CVDs [3].

The Dietary Approaches to Stop Hypertension (DASH) diet, which is rich in fruits, vegetables, and low-fat dairy products, incorporates grains, poultry, fish, and nuts and limits saturated fat, red meat, sweets, and sugar-containing beverages. This eating pattern was basically designed to normalize blood pressure in patients with hypertension, and a large body of data could confirm its beneficial effects on blood pressure levels [4]. In comparison with usual diets the DASH diet provides lower amounts of total fat, saturated fat, and dietary cholesterol, while providing higher amounts of potassium, calcium, magnesium, fiber, and protein. Therefore, some studies have proposed other useful effects of this dietary approach, such as reducing insulin resistance and controlling fasting blood sugar and lipid profiles [5], [6]; thus suggesting it is a good dietary pattern for the prevention of CVDs.

As hypertension is a major risk factor for CVDs, several prospective studies have tried to determine how imitating a DASH-style diet can be associated with the risk for CVDs [7], [8] or one or more of its major subclasses like CHD [7], [8], [9], stroke [7], [8], [9], [10], and HF [11], [12] risk. Mentioned cohort studies have yield inconsistent results. Some researchers believe that adherence to the DASH guidelines was not associated with fatal CVDs [7], [8], ischemic heart disease [7], CHD [8], and stroke [8], [10]; whereas others found a significant independent protective connection with fatal or nonfatal CHD [9], stroke [7], [9], and HF [11], [12].

Cohort studies are the best designs to infer cause-and-effect relationship between independent and dependent variables because exposure always takes place before the outcome in a long-term period and a large population size. Although a large body of literature supports the protective effect of a DASH-style diet on CVDs, according to our knowledge there is no systematic review or meta-analysis, quantifying published longitudinal studies in this regard. Therefore, in present study we tried to systematically review and perform a meta-analysis to summarize the information and assess the magnitude of the relation between imitating a DASH-style diet and CVDs or its major subclasses like CHD, stroke, and HF in prospective cohorts.

Section snippets

Search strategy

Pubmed, ISI web of science, and EMBASE were searched using the following keywords: dietary pattern, DASH, dietary approach to stop hypertension in combination with CVD, CHD, stroke, cardiovascular disease, coronary heart disease, heart failure, and glucose, fasting blood glucose, FBS, insulin, and HOMA-IR, LDL, HDL, TG, low-density lipoprotein, high-density lipoprotein, cholestrol, and triglyceride until January 2012. We also searched “Google scholar” using mentioned keywords to assure that

Results

Our search retrieved 2367 papers. However, after reading the titles and abstracts of the papers only seven studies had all inclusion criteria for systematic review [7], [8], [9], [10], [11], [12], [16]. Further readings revealed that one of these publications by Parikh et al. [7] was done in hypertensive adults, so it was excluded; because hypertension may alter the CVD risk. Therefore, six cohort studies were used for systematic review and meta-analysis. Three studies were from United States

Discussion

Our results showed that imitating a DASH-like diet can significantly reduce risk for CVDs, CHD, stroke, and HF by 20%, 21%, 19%, and 29%, respectively. Furthermore, a significant linear association was shown between concordance with a DASH diet and CVD risk reduction. We are not aware of any systematic review and meta-analysis in this regard quantifying published cohort studies; however, literature reviews have mentioned a DASH-style diet as a practical protective approach for decreasing the

Conclusions

In conclusion, our results showed that a DASH-like diet could significantly protect against CVDs, CHD, stroke, and HF risk by 20%, 21%, 19%, and 29%, respectively. Furthermore, there is a significant reverse linear association between adherance to the DASH diet, CVDs, CHD, stroke, and HF risk. Results found for CHD and stroke must be of course declared with caution because of sensitivity to a single study. More prospective observational studies, particularly from Asian and African regions, are

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    This paper is funded by Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.

    ASA and LA contributed in conception, design, statistical analyses, data interpretation, and manuscript drafting. ASA, ZM, and FS contributed in search and data analysis. All authors contributed in the approval of the final manuscript for submission. ASA, ZM, FS, and LA declared no personal or financial conflicts of interest.

    The authors have declared no personal or financial conflicts of interest.

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