ReviewEffects 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
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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Cited by (0)
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.