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Original Investigation
June 15, 2020

Association Between Healthy Eating Patterns and Risk of Cardiovascular Disease

Author Affiliations
  • 1Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
  • 2Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
  • 3Division of Preventive Medicine, Department of Medicine Research, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
  • 4Division of Women’s Health, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
  • 5Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
  • 6Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
  • 7Now with Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, and Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
  • 8Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
  • 9Now with Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
JAMA Intern Med. Published online June 15, 2020. doi:10.1001/jamainternmed.2020.2176
Key Points

Question  Are there associations of different healthy eating patterns with long-term risk of cardiovascular disease?

Findings  In this cohort study of individuals from the Nurses’ Health Study, Nurses’ Health Study II, and Health Professionals Follow-up Study (165 794 women and 43 339 men) with up to 32 years of follow-up, greater adherence to various healthy eating patterns was associated with lower risk of cardiovascular disease. The associations between dietary scores and risk of cardiovascular disease were consistent across different subgroups.

Meaning  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.

Abstract

Importance  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 Participants  Prospective cohort study of initially healthy women from the Nurses’ Health Study (NHS) (1984-2016) and the NHS II (1991-2017) and men from the Health Professionals Follow-up Study (HPFS) (1986-2012). 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 Measures  Cardiovascular 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 5 257 190 person-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 Relevance  In 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.

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