Dietary Patterns, Smoking, and Cardiovascular Diseases: A Complex Association

Diet and cigarette smoking are key determinants of cardiovascular diseases (CVD). The associations of some nutrients/foods with CVD are unclear, however, and the dietary pattern approach may better inform the relationships. Furthermore, diet and smoking often occur together as part of lifestyle patterns. In this article, studies that evaluated the associations of dietary patterns and smoking status with CVD as well as relationships between lifestyle patterns and CVD were reviewed. Evidence supports the protective role of plant-based dietary patterns for coronary artery disease (CAD) and cardiovascular mortality among nonsmokers and smokers. The interrelationships of dietary patterns and smoking status on subclinical CVD, stroke, hypertension, heart failure, and peripheral arterial disease are inconclusive. Dietary patterns high in refined grains, meats, and sugar-sweetened beverages are harmful, especially for smokers. A healthy lifestyle protects against CAD, hypertension, and cardiovascular mortality, and probably stroke. More prospective studies in diverse populations would be beneficial.