Heavy meals as a trigger for a first event of the acute coronary syndrome: A case-crossover study

Background: Food intake has an immediate effect on the cardiovascular system. However, the effect of a large meal as an immediate trigger for the acute coronary syndrome has not been assessed. Objectives: To assess the relative risk for ACS within a few hours after the ingestion of a heavy meal. Methods: In a case-crossover study, 209 patients were interviewed a median of 2 days after an ACS event. Ingestion of a large meal in the few hours immediately before the onset of ACS was compared with the comparable few hours the day before and with the usual frequency of large meals over the past year. Large meals were assessed according to a 5 level scale. Results: The relative risk of an acute coronary event during the first hour after a heavy meal ingestion was RR = 7 (95% confidence interval 0.75-65.8) when the day before the ACS served as the control data and RR = 4 (95% CI 1.9-8.6) when the usual frequency of heavy meals ingestion during the previous year served as the control data. Conclusions: The ingestion of heavy meals can trigger the onset of an ACS event. Education of the population to avoid heavy meals, especially in people at high risk for coronary heart disease, should be included in the prevention of ACS. Research regarding specific nutrients that may act as potential triggers for ACS should be considered.