Eating late and skipping breakfast raises risk of death, repeat events in STEMI patients

Eating a late dinner and skipping breakfast could raise heart patients’ risk of a repeat MI or death by up to fivefold, according to research published in the European Journal of Preventive Cardiology April 17.

Passing on breakfast has long been associated with poorer overall health, study author Marcos Minicucci, MD, PhD, and colleagues wrote in the journal, and we know people who opt for late-night meals are also more likely to smoke and be physically inactive. But it’s not as clear how those habits affect patients with acute coronary syndromes (ACS).

“It is said that the best way to live is to breakfast like a king,” Minicucci, of Sao Paolo State University in Brazil, said in a release, noting the most beneficial breakfasts will include dairy, carbohydrates and whole fruits and comprise up to 35% of a person’s total daily caloric intake. He and his team included 113 patients in their study, all of whom were ST-segment elevation MI (STEMI) patients who were asked about their eating behaviors on admission to a coronary ICU.

For the purposes of the study, the authors considered skipping breakfast as eating nothing before lunch—excluding drinks like coffee and water—at least three times a week. Late-night dinners weren’t necessarily meals eaten late at night, but rather dinners eaten within two hours of bedtime at least three times a week.

Almost all participants, who were on average 60 years old and 73% men, reported they ate late at night, even if that didn’t meet the study’s “late dinner” threshold. Using the authors’ definitions, 51% of the pool said they ate a late meal, 58% reported skipping breakfast and 41% reported both behaviors.

In the 30 days following hospital discharge for an ACS event, 5.3% of study participants died, Minicucci et al. said, and 17.7% experienced reinfarction or postinfarction angina. The researchers’ primary composite endpoint of death, reinfarction and postinfarction angina within a month of discharge was met by 23% of the population.

“Our research shows that the two eating behaviors are independently linked with poorer outcomes after a heart attack, but having a cluster of bad habits will only make things worse,” Minicucci said. “People who work late may be particularly susceptible to having a late supper and then not being hungry in the morning.

“We also think that the inflammatory response, oxidative stress and endothelial function could be involved in the association between unhealthy eating behaviors and cardiovascular outcomes.”

In addition, the authors found statin use before hospital admission was higher in patients with unhealthy eating habits than in those without—76.2% of patients who ate late and 72% of patients who saw worse outcomes reported taking statins—but statin users were also less likely to consume high levels of saturated fat than non-users.

Minicucci said those findings suggest patients with STEMI might perceive statins as an alternative path to health.

“These drugs should be an addition to healthy eating habits, not a replacement,” he said.