Increased Dietary Acid Load May Elevate the Risk of Coronary Artery Disease Severity: Findings From a Cross-Sectional Study Publisher



Ghorbani Z^{1, 2} ; Dashti F^{1, 3} ; Saeedirad Z⁴ ; Aris A¹ ; Mahdaviroshan M^{1, 2} ; Salari A¹
Source: International Journal of Cardiology: Cardiovascular Risk and Prevention Published:2025

Abstract

Background: Chronic low-grade metabolic acidosis appears to play a role in the development of chronic disorders. This study aims to examine the relationship between Potential Renal Acid Load (PRAL) and Net Endogenous Acid Production (NEAP) and the risk of severe coronary artery disease (CAD) in participants undergoing elective angiography. Methods: In this cross-sectional study, the data of 895 participants from the Nutrition Heshmat Registry (NUTHER) was collected. Dietary data were obtained using a validated food frequency questionnaire to calculate PRAL and NEAP. Participants were categorized into severe CAD (Gensini score≥60; n = 526) and non-severe CAD (Gensini score<60; n = 369). Logistic regression was conducted to evaluate the odds ratio (OR) and 95 % confidence interval (95 %CI). Restricted cubic spline (RCS) regression was employed to explore potential nonlinear associations between PRAL, and NEAP and severe-CAD risk. Results: After adjusting for potential confounding factors, participants in the third to fourth quartiles of energy-adjusted PRAL and NEAP exhibited higher odds of severe CAD that were approximately 1.62–1.80 times and 1.67–2.76 times greater, respectively, compared to those in the 1stquartiles (4thquartile ORs(95 %CI) for: PRAL: 1.62 (1.05, 2.51); and NEAP: 1.67 (1.07, 2.61) (P-for-trend<0.021). RCS analysis showed a linear dose-response relationship between elevated PRAL and severe CAD risk (P-for-overall-trend = 0.0176; P-for-nonlinearity = 0.1552), and a nonlinear association between higher NEAP and increased severe CAD risk (P-for-overall-trend = 0.0001; P-for-nonlinearity = 0.006). Conclusion: The findings indicate a significant association between higher dietary acid load and increased risk of severe CAD, suggesting that a more acidic diet may contribute to the progression of atherosclerosis. However, further prospective studies are necessary to validate these observations. © 2025 The Authors