Yogurt Intake and Risk of Cardiovascular Disease Among Hypertensive Individuals: Is It Time for a Clinical Trial?

Yogurt Intake and Risk of Cardiovascular Disease Among Hypertensive Individuals: Is It Time for a... In a current issue of the American Journal of Hypertension, Buendia et al.1 report that at least 2 serves of yogurt per week were associated with lower risk of myocardial infarction in men and women and lower risk of myocardial infarction, stroke, and revascularization medical procedure in women. The study did not include a reference group, i.e., a group with normal blood pressure (BP) and free of cardiovascular disease or a reference group employing persons with diabetes mellitus and normal BP. Thus, we learn that yogurt consumption reduces the risk of adverse cardiovascular events associated with hypertension, but not if yogurt is uniquely beneficial to hypertensive individuals. To our knowledge, there is no evidence for a special benefit of yogurt consumption in hypertensive individuals as compared to groups with other risk factors. In fact, there is evidence that yogurt is beneficial for individuals with risk factors other than hypertension. In a recent well-controlled study of middle aged adults by Wang et al.,2 “yogurt consumers had lower levels of triglycerides (107.0 [95% confidence interval {CI}, 104.2–109.8] vs. 111.2 [108.4–114.0] mg/dL), fasting glucose (97.2 [96.5–97.9] vs. 98.7 [98.0–99.5] mg/dL), and insulin (81.4 [79.9–82.9] vs. 83.8 [82.2–85.4] pool/L), systolic BP (120.2 [119.5–120.9] vs. 121.7 [121.0–122.3] mm Hg).” A number of potential mechanisms explaining the Buendia et al.1 findings were discussed, but one can only speculate that yogurt was associated with lower BP which in turn was a mediator of reduced risk for myocardial infarction, stroke, and the need for revascularization procedures. Buendia et al.1 did not present data on yogurt in relation to BP values for their study participants. Data on hypertension and other risk factors in the Nurses’ Health Study are based on self-report; thus, objective measures of BP were not available to the study. However, Wang et al.2 reported that greater consumption (≥3 servings/day or week vs. <1 serving) of total dairy, yogurt, skimmed/low-fat milk, and fermented milk products was associated with a 0.2–0.6 mm Hg smaller increment in systolic BP/year. We performed a reanalysis of wave 6 dairy data from the Maine–Syracuse Longitudinal Study.3 We found a modest linear decrease in systolic and diastolic BP across increasing yogurt and dairy dessert intakes (Table 1). Participants who consumed yogurt with dairy desserts ≥2 times per week exhibited significantly modestly lower systolic and diastolic BP than those who never consumed yogurt and dairy desserts (P < 0.05). This was true with statistical adjustment for other risk factors and other dairy foods. The same trend was observed for both systolic BP (P = 0.022) and diastolic BP (P = 0.035) when the sample was restricted to hypertensive individuals (systolic BP > 140; diastolic BP > 90) (n = 570). Table 1. Associations between systolic and diastolic blood pressure across intake of yogurt and dairy desserts for the full sample of persons with hypertension and normal blood pressure Modela Yogurt and dairy dessert intake P Never (n = 265) ≤1 Per week (n = 384) ≥2 Per week (n = 274) M SEM M SEM M SEM SBP (mm Hg) Basic 133.41b 1.23 131.25b 1.00 127.46c,d 1.20 0.002 Extended 132.73b 1.21 131.14 0.97 128.28a 1.19 0.036 DBP (mm Hg) Basic 71.68b 0.59 70.45 0.48 69.11c 0.58 0.010 Extended 71.61b 0.60 70.42 0.48 69.23c 0.59 0.024 Modela Yogurt and dairy dessert intake P Never (n = 265) ≤1 Per week (n = 384) ≥2 Per week (n = 274) M SEM M SEM M SEM SBP (mm Hg) Basic 133.41b 1.23 131.25b 1.00 127.46c,d 1.20 0.002 Extended 132.73b 1.21 131.14 0.97 128.28a 1.19 0.036 DBP (mm Hg) Basic 71.68b 0.59 70.45 0.48 69.11c 0.58 0.010 Extended 71.61b 0.60 70.42 0.48 69.23c 0.59 0.024 Mean and SD age (61.97; 12.77), education (14.66; 2.70), gender (M = 40.74%; F = 59.26%). Abbreviations: DBP, diastolic blood pressure; SBP, systolic blood pressure. aBasic model: age, gender, education, ethnicity. Extended model: Basic model + physical activity (MET hours), smoking, diabetes, antihypertensive medications, waist circumference, plasma homocysteine, folic acid, total grains per day, total fruits per day, total vegetables per day, total meats per day, total milk per day, total cheese per day. bMean significantly different from ≥2 per week group (analysis of covariance). cMean significantly different from Never group (analysis of covariance). dMean significantly different from ≤1 per week group (analysis of covariance). View Large Table 1. Associations between systolic and diastolic blood pressure across intake of yogurt and dairy desserts for the full sample of persons with hypertension and normal blood pressure Modela Yogurt and dairy dessert intake P Never (n = 265) ≤1 Per week (n = 384) ≥2 Per week (n = 274) M SEM M SEM M SEM SBP (mm Hg) Basic 133.41b 1.23 131.25b 1.00 127.46c,d 1.20 0.002 Extended 132.73b 1.21 131.14 0.97 128.28a 1.19 0.036 DBP (mm Hg) Basic 71.68b 0.59 70.45 0.48 69.11c 0.58 0.010 Extended 71.61b 0.60 70.42 0.48 69.23c 0.59 0.024 Modela Yogurt and dairy dessert intake P Never (n = 265) ≤1 Per week (n = 384) ≥2 Per week (n = 274) M SEM M SEM M SEM SBP (mm Hg) Basic 133.41b 1.23 131.25b 1.00 127.46c,d 1.20 0.002 Extended 132.73b 1.21 131.14 0.97 128.28a 1.19 0.036 DBP (mm Hg) Basic 71.68b 0.59 70.45 0.48 69.11c 0.58 0.010 Extended 71.61b 0.60 70.42 0.48 69.23c 0.59 0.024 Mean and SD age (61.97; 12.77), education (14.66; 2.70), gender (M = 40.74%; F = 59.26%). Abbreviations: DBP, diastolic blood pressure; SBP, systolic blood pressure. aBasic model: age, gender, education, ethnicity. Extended model: Basic model + physical activity (MET hours), smoking, diabetes, antihypertensive medications, waist circumference, plasma homocysteine, folic acid, total grains per day, total fruits per day, total vegetables per day, total meats per day, total milk per day, total cheese per day. bMean significantly different from ≥2 per week group (analysis of covariance). cMean significantly different from Never group (analysis of covariance). dMean significantly different from ≤1 per week group (analysis of covariance). View Large The paramount methodological issues are that dietary inventories require self-report and wording in questionnaires does not allow a pure estimate of yogurt consumption in isolation from other dairy products or in exact quantities. Observational studies with specified amounts of yogurt and objective measurement of BP seem an important precursor to large controlled clinical trials. We hypothesize that clinically important relations among yogurt, BP, and hypertension-related comorbidity will be found when yogurt diets are combined with other dairy products.4 DISCLOSURE The authors declared no conflict of interest. REFERENCES 1. Buendia JR , Li Y , Hu FB , Cabral HJ , Bradlee ML , Quatromoni PA , Singer MR , Curhan GC , Moore LL . Regular yogurt intake and risk of cardiovascular disease among hypertensive adults . Am J Hypertens 2018 ; 31 : 557 – 565 . Google Scholar CrossRef Search ADS PubMed 2. Wang H, Livingston KA, Fox CS, Meigs, JB. Yogurt consumption is associated with better diet quality and metabolic profile in American men and women. Nutr Res. 2013; 33:18–26. 3. Crichton GE , Elias MF , Dore GA , Abhayaratna WP , Robbins MA . Relations between dairy food intake and arterial stiffness: pulse wave velocity and pulse pressure . Hypertension 2012 ; 59 : 1044 – 1051 . Google Scholar CrossRef Search ADS PubMed 4. Crichton GE , Alkerwi A . Dairy food intake is positively associated with cardiovascular health: findings from Observation of Cardiovascular Risk Factors in Luxembourg study . Nutr Res 2014 ; 34 : 1036 – 1044 . Google Scholar CrossRef Search ADS PubMed © American Journal of Hypertension, Ltd 2018. All rights reserved. For Permissions, please email: journals.permissions@oup.com This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/about_us/legal/notices) http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png American Journal of Hypertension Oxford University Press

Yogurt Intake and Risk of Cardiovascular Disease Among Hypertensive Individuals: Is It Time for a Clinical Trial?

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Publisher
Oxford University Press
Copyright
© American Journal of Hypertension, Ltd 2018. All rights reserved. For Permissions, please email: journals.permissions@oup.com
ISSN
0895-7061
eISSN
1941-7225
D.O.I.
10.1093/ajh/hpy086
Publisher site
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Abstract

In a current issue of the American Journal of Hypertension, Buendia et al.1 report that at least 2 serves of yogurt per week were associated with lower risk of myocardial infarction in men and women and lower risk of myocardial infarction, stroke, and revascularization medical procedure in women. The study did not include a reference group, i.e., a group with normal blood pressure (BP) and free of cardiovascular disease or a reference group employing persons with diabetes mellitus and normal BP. Thus, we learn that yogurt consumption reduces the risk of adverse cardiovascular events associated with hypertension, but not if yogurt is uniquely beneficial to hypertensive individuals. To our knowledge, there is no evidence for a special benefit of yogurt consumption in hypertensive individuals as compared to groups with other risk factors. In fact, there is evidence that yogurt is beneficial for individuals with risk factors other than hypertension. In a recent well-controlled study of middle aged adults by Wang et al.,2 “yogurt consumers had lower levels of triglycerides (107.0 [95% confidence interval {CI}, 104.2–109.8] vs. 111.2 [108.4–114.0] mg/dL), fasting glucose (97.2 [96.5–97.9] vs. 98.7 [98.0–99.5] mg/dL), and insulin (81.4 [79.9–82.9] vs. 83.8 [82.2–85.4] pool/L), systolic BP (120.2 [119.5–120.9] vs. 121.7 [121.0–122.3] mm Hg).” A number of potential mechanisms explaining the Buendia et al.1 findings were discussed, but one can only speculate that yogurt was associated with lower BP which in turn was a mediator of reduced risk for myocardial infarction, stroke, and the need for revascularization procedures. Buendia et al.1 did not present data on yogurt in relation to BP values for their study participants. Data on hypertension and other risk factors in the Nurses’ Health Study are based on self-report; thus, objective measures of BP were not available to the study. However, Wang et al.2 reported that greater consumption (≥3 servings/day or week vs. <1 serving) of total dairy, yogurt, skimmed/low-fat milk, and fermented milk products was associated with a 0.2–0.6 mm Hg smaller increment in systolic BP/year. We performed a reanalysis of wave 6 dairy data from the Maine–Syracuse Longitudinal Study.3 We found a modest linear decrease in systolic and diastolic BP across increasing yogurt and dairy dessert intakes (Table 1). Participants who consumed yogurt with dairy desserts ≥2 times per week exhibited significantly modestly lower systolic and diastolic BP than those who never consumed yogurt and dairy desserts (P < 0.05). This was true with statistical adjustment for other risk factors and other dairy foods. The same trend was observed for both systolic BP (P = 0.022) and diastolic BP (P = 0.035) when the sample was restricted to hypertensive individuals (systolic BP > 140; diastolic BP > 90) (n = 570). Table 1. Associations between systolic and diastolic blood pressure across intake of yogurt and dairy desserts for the full sample of persons with hypertension and normal blood pressure Modela Yogurt and dairy dessert intake P Never (n = 265) ≤1 Per week (n = 384) ≥2 Per week (n = 274) M SEM M SEM M SEM SBP (mm Hg) Basic 133.41b 1.23 131.25b 1.00 127.46c,d 1.20 0.002 Extended 132.73b 1.21 131.14 0.97 128.28a 1.19 0.036 DBP (mm Hg) Basic 71.68b 0.59 70.45 0.48 69.11c 0.58 0.010 Extended 71.61b 0.60 70.42 0.48 69.23c 0.59 0.024 Modela Yogurt and dairy dessert intake P Never (n = 265) ≤1 Per week (n = 384) ≥2 Per week (n = 274) M SEM M SEM M SEM SBP (mm Hg) Basic 133.41b 1.23 131.25b 1.00 127.46c,d 1.20 0.002 Extended 132.73b 1.21 131.14 0.97 128.28a 1.19 0.036 DBP (mm Hg) Basic 71.68b 0.59 70.45 0.48 69.11c 0.58 0.010 Extended 71.61b 0.60 70.42 0.48 69.23c 0.59 0.024 Mean and SD age (61.97; 12.77), education (14.66; 2.70), gender (M = 40.74%; F = 59.26%). Abbreviations: DBP, diastolic blood pressure; SBP, systolic blood pressure. aBasic model: age, gender, education, ethnicity. Extended model: Basic model + physical activity (MET hours), smoking, diabetes, antihypertensive medications, waist circumference, plasma homocysteine, folic acid, total grains per day, total fruits per day, total vegetables per day, total meats per day, total milk per day, total cheese per day. bMean significantly different from ≥2 per week group (analysis of covariance). cMean significantly different from Never group (analysis of covariance). dMean significantly different from ≤1 per week group (analysis of covariance). View Large Table 1. Associations between systolic and diastolic blood pressure across intake of yogurt and dairy desserts for the full sample of persons with hypertension and normal blood pressure Modela Yogurt and dairy dessert intake P Never (n = 265) ≤1 Per week (n = 384) ≥2 Per week (n = 274) M SEM M SEM M SEM SBP (mm Hg) Basic 133.41b 1.23 131.25b 1.00 127.46c,d 1.20 0.002 Extended 132.73b 1.21 131.14 0.97 128.28a 1.19 0.036 DBP (mm Hg) Basic 71.68b 0.59 70.45 0.48 69.11c 0.58 0.010 Extended 71.61b 0.60 70.42 0.48 69.23c 0.59 0.024 Modela Yogurt and dairy dessert intake P Never (n = 265) ≤1 Per week (n = 384) ≥2 Per week (n = 274) M SEM M SEM M SEM SBP (mm Hg) Basic 133.41b 1.23 131.25b 1.00 127.46c,d 1.20 0.002 Extended 132.73b 1.21 131.14 0.97 128.28a 1.19 0.036 DBP (mm Hg) Basic 71.68b 0.59 70.45 0.48 69.11c 0.58 0.010 Extended 71.61b 0.60 70.42 0.48 69.23c 0.59 0.024 Mean and SD age (61.97; 12.77), education (14.66; 2.70), gender (M = 40.74%; F = 59.26%). Abbreviations: DBP, diastolic blood pressure; SBP, systolic blood pressure. aBasic model: age, gender, education, ethnicity. Extended model: Basic model + physical activity (MET hours), smoking, diabetes, antihypertensive medications, waist circumference, plasma homocysteine, folic acid, total grains per day, total fruits per day, total vegetables per day, total meats per day, total milk per day, total cheese per day. bMean significantly different from ≥2 per week group (analysis of covariance). cMean significantly different from Never group (analysis of covariance). dMean significantly different from ≤1 per week group (analysis of covariance). View Large The paramount methodological issues are that dietary inventories require self-report and wording in questionnaires does not allow a pure estimate of yogurt consumption in isolation from other dairy products or in exact quantities. Observational studies with specified amounts of yogurt and objective measurement of BP seem an important precursor to large controlled clinical trials. We hypothesize that clinically important relations among yogurt, BP, and hypertension-related comorbidity will be found when yogurt diets are combined with other dairy products.4 DISCLOSURE The authors declared no conflict of interest. REFERENCES 1. Buendia JR , Li Y , Hu FB , Cabral HJ , Bradlee ML , Quatromoni PA , Singer MR , Curhan GC , Moore LL . Regular yogurt intake and risk of cardiovascular disease among hypertensive adults . Am J Hypertens 2018 ; 31 : 557 – 565 . Google Scholar CrossRef Search ADS PubMed 2. Wang H, Livingston KA, Fox CS, Meigs, JB. Yogurt consumption is associated with better diet quality and metabolic profile in American men and women. Nutr Res. 2013; 33:18–26. 3. Crichton GE , Elias MF , Dore GA , Abhayaratna WP , Robbins MA . Relations between dairy food intake and arterial stiffness: pulse wave velocity and pulse pressure . Hypertension 2012 ; 59 : 1044 – 1051 . Google Scholar CrossRef Search ADS PubMed 4. Crichton GE , Alkerwi A . Dairy food intake is positively associated with cardiovascular health: findings from Observation of Cardiovascular Risk Factors in Luxembourg study . Nutr Res 2014 ; 34 : 1036 – 1044 . Google Scholar CrossRef Search ADS PubMed © American Journal of Hypertension, Ltd 2018. All rights reserved. For Permissions, please email: journals.permissions@oup.com This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/about_us/legal/notices)

Journal

American Journal of HypertensionOxford University Press

Published: May 21, 2018

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