Increased Yogurt Intake Lowers Risk of Cardiovascular Disease among Middle‐Aged Adults with High Blood Pressure

Background High blood pressure (HBP) is a major risk factor for cardiovascular disease (CVD), the leading cause of mortality worldwide. Short‐term clinical trials have found beneficial effects of higher dairy intakes, especially yogurt, on CVD risk among those with HBP. However, long‐term studies are lacking. Objective To estimate the independent effects of total dairy and yogurt on risk of incident CVD among middle‐aged adults with HBP. Secondarily, possible effect modification by a healthy diet pattern was explored. Methods Subjects included 57,768 30–55 year‐old women in the Nurses' Health Study (NHS) and 18,593 40–75 year‐old men in the Health Professionals Follow‐Up Study (HPFS) who reported HBP. Subjects with prevalent CVD, diabetes, or cancer were excluded. Cumulative average dairy intakes were derived from validated, semi‐quantitative food frequency questionnaires every 4 years. CVD, defined as myocardial infarction (MI) or stroke, was ascertained via self‐report with medical record review. NHS and HPFS subjects were followed for incident CVD for up to 30 and 24 years, respectively from the time of first reported HBP diagnosis. Time dependent Cox proportional hazards models were used to calculate hazard ratios (HR) and 95% confidence intervals (CI) while controlling for age, race, family history of HBP or MI, BP medication use, smoking, alcohol, physical activity, BMI, and intakes of energy, fiber and trans fats. A DASH (Dietary Approaches to Stop Hypertension) diet score was calculated to explore effect modification by diet quality. Results There were 5,468 total CVD cases in both cohorts, with 3,678 and 1,790 incident CVD cases in the NHS and HPFS, respectively. Of the 3,678 CVD cases in NHS, 1,887 were MI events and 1,791 strokes. In HPFS, there were 1,267 MI events and 523 incident strokes. Yogurt intake was inversely associated with risk of CVD among those with prevalent HBP ( p for linear trend <0.01 for both NHS and HPFS). Participants who consumed yogurt twice or more weekly in the NHS and HPFS had 17% (95% CI: 0.75–0.92) and 18% (95% CI: 0.68–0.97) reductions on risk of CVD, respectively. The effect of yogurt was further modified by a healthy diet pattern (as measured by a DASH score). Regular yogurt consumers in the NHS (≥2 servings/week) and HPFS (≥1 serving/week) with higher DASH scores (≥25 for both cohorts) had 19% (95% CI: 0.71–0.92) and 31% (95% CI: 0.57–0.83) lower risks of CVD, respectively. Total dairy intake was inversely associated with CVD risk among men. Finally, for participants in both NHS and HPFS whose diet more closely matched that of a DASH diet (DASH score ≥22), consuming ≥1 serving/day of dairy led to 12% (95% CI: 0.79–0.97) and 16% (95% CI: 0.73–0.97) lower risks of CVD, respectively. Conclusion Higher usual yogurt intakes were associated with lower risks of incident CVD in both women and men with prevalent HBP. Total dairy intake was particularly beneficial for men with HBP. When combined with a higher DASH score, higher total dairy and yogurt intakes led to meaningful reductions in CVD risk in both cohorts. These results suggest that incorporation of yogurt into a healthy diet pattern in hypertensive adults may provide a valuable non‐pharmacological approach to CVD prevention. Support or Funding Information National Dairy Council and the Boston Nutrition Obesity Research Center