Associations between cardiometabolic risk factors and dietary patterns in patients after percutaneous coronary intervention: Insights from CONCARDPCI

Coronary artery disease remains a leading cause of morbidity and mortality worldwide. Although percutaneous coronary intervention (PCI) restores myocardial perfusion, patients remain at increased risk of recurrent events due to ongoing atherosclerosis and cardiometabolic risk factors. Dietary intake is a key modifiable determinant of these risk factors, yet evidence on habitual dietary patterns and their association with cardiometabolic risk factors in patients after PCI remains limited. Understanding this association is essential for developing targeted nutritional interventions for secondary prevention.

To identify dietary patterns in patients after PCI and assess the strength of possible association between selected established cardiometabolic risk factors and dietary patterns.

In this prospective multicentred cohort study, patients who underwent PCI were recruited from seven referral centres in Norway and Denmark between June 2017 and May 2020 (N=3417). Clinical and sociodemographic data were obtained from hospital medical records, national registries and self-reported questionnaires. Dietary intake was assessed during index hospitalization using a short food frequency questionnaire (FFQ). Dietary patterns were identified using hierarchical cluster analysis with Ward’s method. Associations between dietary clusters and cardiometabolic risk factor, diabetes status, blood pressure, lipid profile, BMI and waist circumference, were identified using multiple logistic regression.

A total of 2797 patients who responded to the FFQ were available for analyses (mean [SD] age 66 [11] years, 78% men). Two dietary clusters were identified. Cluster 1 (n= 738) was characterized by high consumption of fruits, vegetables and water, and Cluster 2 (n=2226) was characterized by higher consumption of other assessed food groups. Multiple logistic regression analysis, adjusted for age, sex, level of education and treatment for hypertension, showed that patients with diabetes had significantly higher odds of being in Cluster 1(OR=1.49, 95% CI [1.19-1.86], p = 0.001), while patients with hypertension (OR=0.80, 95% CI [0.65-0.98], p=0.031), higher BMI (OR=0.98, 95%CI [0.95-0.99], p=0.039) and larger waist circumference (OR=0.94; 95%CI [0.91-0.98], p=0.003 per 5 cm increase) had lower odds of being in Cluster 1.

Higher intake of fruits, vegetables, and water was associated with a more favourable cardiometabolic risk profile, particularly lower blood pressure, BMI, and waist circumference. The findings suggest that dietary patterns are closely linked to key cardiometabolic risk factors, supporting existing insight on diet as an essential component of secondary prevention after PCI. This insight may reinforce the importance of more targeted nutritional interventions, particularly for patients with hypertension or obesity, to optimize post-PCI preventive care.