Can a healthy Nordic diet counteract atherosclerosis, alter gut microbiota and be personalized to enhance diet response in coronary heart disease?

BackgroundDiet can play a key role in atherosclerosis and coronary heart disease (CHD), but little interventional data exist and the mediators of possible anti-atherosclerotic effects of diet are unclear.

We will examine if a healthy Nordic diet (HND) reduces plaque volume, coronary artery calcification (CAC) or plaque inflammation (FAI) in CHD, and if changes in gut microbiota are linked to plaque progression over time. We will also explore if diet response can be predicted by the metabolic phenotype.

Methods150 CHD patients are randomized to a HND rich in unsaturated fat and fibre from plants or to “usual care diet” for 18months. Primary outcome: change in plaque volume assessed by novel photon-counting CT angiography. Secondary outcomes: CAC and FAI. Exploratory effects: gut microbiota and plasma metabolites.

Fecal microbiota composition and functional profile (genes, pathways) is determined by deep metagenome shotgun sequencing. Biomarkers of diet adherence (plasma fatty acids, whole-grain metabolites) are measured.

Machine-learning is used to identify diet “responders” on plaque progression based on the individual microbiome and metabolome.

SignificanceIf a HND reduces plaque progression, this would be novel and clinically important, and if HND alters the microbiota that are linked to plaque progression, this would be of clear scientific interest.

Also, a potential prediction of the diet-response may open up for more personalized dietary treatment of CHD in the future.