Diets heavy in fried foods, salty snacks and meat account for about 35 percent of heart attacks globally, researchers reported on Monday.
Their study of 52 countries showed that people who ate a "Western" diet based on meat, eggs and junk food were more likely to have heart attacks, while those who ate more fruits and vegetables had a lower risk.
The study supports previous findings that show junk food and animal fats can cause heart disease, and especially heart attacks.
Dr. Salim Yusuf at McMaster University in Ontario, Canada, and colleagues questioned more than 16,000 patients, 5,700 of whom had just suffered a first heart attack.
They took blood samples and had each patient fill out a detailed form on their eating habits between February 1999 and March 2003.
They divided the volunteers into three groups.
"The first factor was labeled 'Oriental' because of its high loading on tofu and soy and other sauces," they wrote in their report, published in the journal Circulation.
"The second factor was labeled 'Western' because of its high loading on fried food, salty snacks, and meat intake. The third dietary factor was labeled 'prudent' because of its high loadings on fruit and vegetable intake."
People who ate more fruits and vegetables had a 30 percent lower risk of heart attack compared to people who ate little or none of these foods, they found.
People eating a Western diet had a 35 percent greater risk of heart attack compared to people who consumed little or no fried foods and meat. Those eating the "Oriental" diet had an average risk of heart attack compared to the others.
The finding is important because it has not been clear if it is food per se or something else driving heart attack risk. Rich diets may be associated with a richer lifestyle that includes little or no exercise, for instance.
But the researchers note that heart disease is no longer an affliction only of the rich.
"Approximately 80 percent of the global cardiovascular disease burden occurs in low- and middle-income countries," they wrote.
The tofu-rich diet could be neutral rather than protective because it is high in sodium, they said. High sodium intake can raise blood pressure and the risk of heart attack and stroke.
