Note for Male Smokers: The Healthy Eating Index Associated With the Risk of Subclinical Myocardial Injury

OBJECTIVES: To investigate the associations of the healthy eating index (HEI) and subclinical myocardial injury (SCMI) in different smoking statuses (current smokers, former smokers, and never smokers) based on the National Health and Nutrition Examination Survey (NHANES) III. METHODS: SCMI was defined as a cardiac infarction injury score (CIIS) ≥ 10. The HEI was compared between individuals with and without SCMI across different smoking status categories. Logistic regression analysis was used to investigate the association between HEI and SCMI stratified by smoking status, as well as in subgroups defined by sex and smoking status. Restricted cubic spline (RCS) modeling was applied to assess the nonlinear relationship between HEI and SCMI risk among male participants. Logistic regression-based classification was further employed to explore the contribution of individual HEI components to SCMI risk in male smokers. RESULTS: A total of 7256 participants (without SCMI group: 5389; SCMI group: 1867) were included. After stratifying by smoking status, a significant difference in HEI was found between the two groups among smokers. Multivariable logistic regression analysis revealed that HEI was inversely associated with the odds of SCMI in smokers. This association was particularly pronounced in male smokers. RCS analysis revealed a negative linear association between HEI and SCMI risk in male smokers. Diet variety and saturated fats were major contributors to this relationship. CONCLUSION: This study demonstrated that in male smokers, HEI scores negatively correlated with SCMI risk, with diet variety and saturated fats being major contributors in the late 1980s to early 1990s.