Heart Attack Patients Illuminate the Deadly Consequences of Skipping Meals

Healthier eating can help limit the progression of heart disease, but for people who already struggle with heart conditions, nutrition is essential. According to research released in the European Journal of Preventative Cardiology, when we eat may be just as important as what we eat — especially for people recovering from heart attacks.

"Most people don’t think this could cause harm."

A research letter published Thursday by Marcos Ferreira Minicucci, Ph.D. of Sao Paulo State University’s department of clinical medicine shows that meal timing can make a huge difference for recovering heart attack patients. Those who ate late dinners and then skipped breakfast the next day were four to five times more likely to die than those who stuck to regular eating patterns.

“We think that nowadays because time is running so fast, we do not have time to have meals, usually during the day we are eating snacks,” Minicucci tells Inverse. “In addition, we are skipping meals or having meals as fast as we can. Most people don’t think this could cause harm.”

For the group of 113 heart attack patients that Minicucci evaluated, irregular eating patterns did cause harm — or at least were associated with far higher risks of death. Considering heart disease is responsible for one in every four deaths in the US, this pattern is a powerful one that could impact many lives.

In terms of this study, “skipping breakfast” meant “not eating anything before lunch” (there’s no time cutoff in the paper). So patients who drank coffee in the morning, for instance, still counted in the skipping breakfast category. Eating dinner late, he added, meant eating dinner within two hours of bedtime.

As Minicucci watched his heart attack patients during their hospital stays and for the first 30 days after discharge, he noted that 40.7 percent of those patients reported both eating dinner within two hours of bedtime and then skipping breakfast the next day. Once he adjusted for other factors that might also correspond with higher risks of death, like smoker status or cholesterol levels, eating late and avoiding breakfast were still associated with higher risks of death.

The paper doesn’t go so far as to explain what might actually be behind this pattern — it’s just an observational study, so there are still some outstanding questions. For example, Minicucci didn’t analyze the types of foods these patients were eating that might have additionally increased their risk. And notably, 73 percent of his patients were men, so these results may not hold true for women.

Overall, his findings seem weirdly specific, but they do have a place in a field of research that’s increasingly torn about the importance of meal timing, both for heart attack patients and for the general population. 

"We use these kind of studies to formulate a hypothesis."

For example, a 2014 study in Scientifica on 60,800 Japanese adults showed that people who ate later dinners and skipped breakfast had 17 percent higher odds of having metabolic syndrome — increasing their risk for heart conditions. That data adds some credence to this paper, but it doesn’t explain what might be driving the relationship between heart health and the late-dinner-no-breakfast combination.

One idea is that we should really be focusing on the skipped breakfast side of the equation.

A review published in Circulation in 2017 points to the idea that late night meals are actually one of the biggest predictors of skipped breakfasts. Minicucci notes this too: “People who work late may be particularly susceptible to having a late supper and then not being hungry in the morning,” he said on Thursday. The question is, what happens when people skip breakfast because they’re too full when they go to sleep?

Some research suggests that skipping breakfast isn’t good news. For example, one paper published in Stroke in 2016 showed that men who skipped breakfast had 14 percent higher rates of heart disease compared to men who didn’t skip breakfast, highlighting how breakfast may impact metabolic health. However, when it comes to weight loss, other review papers suggest that eating breakfast may not be a silver bullet for keeping weight off — despite its popular status as “the most important meal of the day.”

In terms of the general population, it’s still hard to pin down a cause-and-effect relationship between meal timing and heart health — maybe because there are so many different factors that determine what, and crucially, when someone eats. But for the heart attack patients that Minicucci studied, it seems that meal timing really does make a difference on their road to recovery, though he adds this will need to be replicated in more studies to come.

“This is the first article that evaluates these habits in patients after myocardial infarction,” he adds. “We use these kind of studies to formulate a hypothesis.”

If a simple change in meal timing can offset the risks that heart attack survivors face on a daily basis, it’s worth looking into the connection.