Abstract
BACKGROUND: Although dietary approaches to stop hypertension (DASH) and Mediterranean diets have been shown to reduce cardiovascular risk, their regional applicability may be limited. The PURE healthy diet, with an emphasis on consumption of certain food groups rather than limiting others, may provide a more culturally appropriate approach. This study aimed to investigate the association between adherence to the PURE healthy diet and the risk of premature coronary artery disease (PCAD) among Iranians. METHODS: This multicenter case-control study included 3,183 participants (2,032 cases and 1,151 controls) from 14 cities in Iran. Dietary intake was assessed using a validated food frequency questionnaire. The PURE healthy diet score was calculated based on six food categories: fruits, vegetables, legumes, nuts, fish, and dairy products. The association between the PURE healthy diet score and PCAD risk was analyzed using logistic regression. RESULTS: Greater adherence to the PURE healthy diet was associated with a significant reduction in PCAD risk. Participants in the highest quartile had a 66% lower likelihood of having PCAD compared to those in the lowest quartile (OR = 0.34; 95% CI: 0.26-0.46; p < 0.001). Nuts (OR = 0.56, 95% CI: 0.43-0.73, P for trend < 0.001) and legumes (OR = 0.72, 95% CI: 0.55-0.95, P for trend < 0.004) were major contributors to this protection, as their removal weakened the association. CONCLUSIONS: The PURE healthy diet shows strong potential in reducing the risk of PCAD, with this inverse association persisting even after excluding one of the six food groups. However, longitudinal studies are essential to confirm these findings.