Association Between Healthy Eating Patterns and Risk of Cardiovascular Disease

Abstract

The 2015-2020 Dietary Guidelines for Americans recommend multiple healthy eating patterns. However, few studies have examined the associations of adherence to different dietary patterns with long-term risk of cardiovascular disease (CVD).OBJECTIVE To examine the associations of dietary scores for 4 healthy eating patterns with risk of incident CVD. DESIGN, SETTING, AND PARTICIPANTSProspective cohort study of initially healthy women from the Nurses' Health Study (NHS) and the NHS II and men from the Health Professionals Follow-up Study (HPFS) . The dates of analysis were July 25 to December 4, 2019.EXPOSURES Healthy Eating Index-2015 (HEI-2015, Alternate Mediterranean Diet Score (AMED), Healthful Plant-Based Diet Index (HPDI), and Alternate Healthy Eating Index (AHEI). MAIN OUTCOMES AND MEASURESCardiovascular disease events, including fatal and nonfatal coronary heart disease (CHD) and stroke. RESULTS The final study sample included 74 930 women in the NHS (mean [SD] baseline age, 50.2 [7.2] years), 90 864 women in the NHS II (mean [SD] baseline age, 36.1 [4.7] years), and 43 339 men in the HPFS (mean [SD] baseline age, 53.2 [9.6] years). During a total of 5 257 190person-years of follow-up, 23 366 incident CVD cases were documented (18 092 CHD and 5687 stroke) (some individuals were diagnosed as having both CHD and stroke). Comparing the highest with the lowest quintiles, the pooled multivariable-adjusted hazard ratios (HRs) of CVD were 0.83 (95% CI, 0.79-0.86) for the HEI-2015, 0.83 (95% CI, 0.79-0.86) for the AMED, 0.86 (95% CI, 0.82-0.89) for the HPDI, and 0.79 (95% CI, 0.75-0.82) for the AHEI (P for trend <.001 for all). In addition, a 25-percentile higher dietary score was associated with 10% to 20% lower risk of CVD (pooled HR, 0.80 [95% CI, 0.77-0.83] for the HEI-2015; 0.90 [95% CI, 0.87-0.92] for the AMED; 0.86 [95% CI, 0.82-0.89] for the HPDI; and 0.81 [95% CI, 0.78-0.84] for the AHEI). These dietary scores were statistically significantly associated with lower risk of both CHD and stroke. In analyses stratified by race/ethnicity and other potential risk factors for CVD, the inverse associations between these scores and risk of CVD were consistent in most subgroups. CONCLUSIONS AND RELEVANCEIn 3 large prospective cohorts with up to 32 years of follow-up, greater adherence to various healthy eating patterns was consistently associated with lower risk of CVD. These findings support the recommendations of the 2015-2020 Dietary Guidelines for Americans that multiple healthy eating patterns can be adapted to individual food traditions and preferences.

Changes in plant-based diet quality and health-related quality of life in women

“…The correlations between our healthful PDI and the Alternate Healthy Eating Index were 0•67 in the NHS and 0•68 in the NHSII. The correlations between our index and the Alternate Mediterranean Diet score were 0•37 in the NHS and 0•35 in the NHSII (47) . However, our plant-based diet indices are different from these other dietary indices in several aspects.…”

Interaction between Long-Term Exposure to Fine Particulate Matter and Physical Activity, and Risk of Cardiovascular Disease and Overall Mortality in U.S. Women

“…Methods to confirm incident CVD have been published in detail elsewhere (Hart et al 2015b;Shan et al 2020;Yu et al 2016). Incident CVD was determined as the first occurrence of either fatal and nonfatal acute MI (ICD-9 code 410) or stroke (ICD-9 codes 430 to 437).…”

Inflammation in Obesity-Related Complications in Children: The Protective Effect of Diet and Its Potential Role as a Therapeutic Agent

“…This is the case of the Mediterranean diet, traditionally rich in fiber from cereals such as whole-grain bread, pasta, couscous and other unrefined grains, and is rich in micronutrients and phytochemicals from fruit and vegetables of different colors and textures with many different potential health benefits [136][137][138]. Bioactive compounds like phenolic compounds, flavonoids, plant sterols, and carotenoids of plant origin are protective against chronic diseases, mainly thanks to their action upon lipid profile, endothelial function, and inflammatory mediators [139,140]. In particular, in vitro studies have amply demonstrated the beneficial effects on inflammation associated with the antioxidant activity of polyphenols, especially flavonoids such as flavonols, flavones, isoflavones, anthocyanidins, resveratrol, curcumin, tannins and lignans.…”