Low-fibre diet is associated with high-risk coronary plaque features

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 Cardiovasc Res. 2025 Jun 16;121(8):1204–1214. doi: 10.1093/cvr/cvaf088

Low-fibre diet is associated with high-risk coronary plaque features

Ingrid Larsson 1,2, Jiangming Sun 3, Shafqat Ahmad 4,5,6, Göran Bergström 7,8, Carl-Johan Carlhäll 9,10,11, Kerstin Cederlund 12, Isabel Drake 13, Jan E Engvall 14,15,16, Mats Eriksson 17, Henrik Hagström 18, Tomas Jernberg 19, Tanja Kero 20,21, Krister Lindmark 22,23, Maria Mannila 24, Marju Orho-Melander 25, Araz Rawshani 26,27, Ulf Risérus 28, Annika Rosengren 29,30, Mats Ryberg 31, Caroline Schmidt 32, Emily Sonestedt 33, Maria Wennberg 34, Carl Johan Östgren 35,36, Isabel Goncalves 37,38,2,✉,3

Introduction

Diet is an important determinant of disease.1 

The Mediterranean diet and similar patterns2 

have been associated with lower risk of cardiovascular morbidity3 and mortality.2,4,5

Different dietary indices have identified patterns, such as the Mediterranean and other high-fibre diets, as likely to be associated with lower risk of disease.5 

Cardiovascular disease (CVD) remains the most important cause of death and disability,6 

with coronary disease a predominant cause of pre-mature death.

 The most common underlying pathology is atherosclerosis, where plaques are formed along decades, with some prone to rupture,7 

causing myocardial infarction, or sudden coronary death. However, the occurrence of coronary events is not only associated with the degree of stenosis caused by a plaque, 

but also with plaque composition.8

Still, accessible non-invasive diagnostic methods to detect rupture-prone plaques have been lacking. In recent years, coronary computed tomography angiography (CCTA) has emerged as promising and is recommended in international guidelines for risk stratification for low/moderate risk patients.9,10 

Plaques with adverse or high-risk features, for example low attenuation on CCTA in combination with significant stenosis, have been linked to a higher risk for cardiovascular events.11,12

Dietary patterns that include a high intake of vegetables, fruits, and whole-grain cereals are associated with lower risk of CVD.1,3,13 

Dietary indices have been used as composite variables constructed from food items known à priori to be healthy, alternatively unhealthy.5,13

Kaluza et al.14 identified food items from a food frequency questionnaire (FFQ), that correlated to indices of inflammation such as elevated levels of high sensitivity C-reactive protein (hsCRP) and grouped them into a diet index (DI) including foods with anti-inflammatory potential (fruits and vegetables, nuts, whole-grain bread, breakfast cereals and oat-meal, low-fat cheese, canola- and olive-oil, coffee, tea, chocolate, red wine, and beer) and foods with pro-inflammatory potential, (unprocessed and processed red meat, offal, potato chips, and sugar-sweetened beverages).14 In Swedish prospective cohort studies, men and women with high DI and low intake of foods with pro-inflammatory potential had lower risk of mortality,15 

abdominal aortic aneurysm,16 

and heart failure17 after 16 years follow-up, compared to those with low DI. Using isotope-ratio mass spectrometry, it was demonstrated that dietary intake is reflected in rupture-prone plaque components.18

However, potential associations between diet intake and the presence of coronary artery plaque, or their features, in CCTA remain unexplored in large population-based cohorts.

The aim of this study was to analyse whether diet intake assessed by a DI based on the anti-inflammatory DI by Kaluza et al.14

is associated with coronary atherosclerosis, coronary plaque features assessed by CCTA and known cardiovascular risk factors, in a randomly selected, population-based cohort of middle-aged Swedish subjects.

 The hypothesis was that lower intake of fibre-rich components and higher intake of red and processed meat in the diet was associated with more adverse or high-risk coronary plaque features