Abstract 37: Healthy Eating Patterns and Risk of Cardiovascular Disease: Results From Three Large Prospective Cohort Studies

Introduction: The 2015-2020 Dietary Guidelines for Americans (DGAs) recommend three major healthy dietary patterns: the Healthy US-Style Eating Pattern, the Healthy Mediterranean-Style Eating Pattern, and the Healthy Vegetarian Eating Pattern, for all Americans with diverse cultural and personal food traditions. However, few studies have systematically examined the potential differences in associations of adherence to these recommended dietary patterns with long-term risk of cardiovascular disease (CVD). Hypothesis: We hypothesized that all three DGA-recommended dietary patterns were associated with lower risk of CVD, coronary heart disease (CHD), and stroke. Method: We evaluated data on 74 661 women in the Nurses’ Health Study (NHS), 90 864 women in NHS II, and 41 837 men in the Health Professionals Follow-Up Study (HPFS), who had repeated dietary data and had no history of type 2 diabetes, CVD, or cancer at baseline. Using the food and nutrient components, we calculated the Healthy Eating Index (HEI)-2015, Alternate Mediterranean Diet score (AMED), Healthful Plant-based Diet Index (HPDI), to measure adherence to the Healthy US-Style Eating Pattern, Healthy Mediterranean-Style Eating Pattern, and Healthy Vegetarian Eating Pattern, respectively. Multivariable Cox proportional-hazards regression was used to assess the associations of healthy eating index with CVD risk. Results: We documented 9 262 incident CVD cases (6 628 CHD and 2 701 stroke) during 1 976 026 person years of follow-up in the NHS, 1 916 CVD cases (1 267 CHD and 660 stroke) during 2 173 162 person years of follow-up in NHS II, and 10 203 CVD cases (8 750 CHD and 1 775 stroke) during 873 053 person years of follow-up in HPFS. When comparing the highest to the lowest quintiles, the pooled HRs (95% CIs) of CVD were 0.80 (0.77 to 0.84) for HEI-2015, 0.83 (0.79 to 0.87) for AMED, and 0.85 (0.81 to 0.89) for HPDI (all P for trend <0.001). In addition, a 25-percentile increase in healthy eating scores was associated with 10% to 22% lower risk of CVD (pooled HR: HEI-2015, 0.78 [0.75 to 0.82]; AMED, 0.90 [0.88 to 0.92]; HPDI, 0.84 [0.81 to 0.88]). For CHD, the pooled HRs (95% CIs) per 20-percentile increase were 0.76 (0.73 to 0.80) for HEI-2015, 0.90 (0.87 to 0.92) for AMED, and 0.83 (0.79 to 0.87) for HPDI. For stroke, the pooled HRs (95% CIs) per 20-percentile increase were 0.86 (0.78 to 0.94) for HEI-2015, 0.90 (0.85 to 0.95) for AMED, and 0.90 (0.83 to 0.98) for HPDI. The inverse associations between healthy eating index and CVD risk persisted in analyses stratified by potential risk factors. Conclusions: In three large prospective cohorts with up to 32 years of follow-up, higher adherence to various healthy eating patterns was associated with lower risk of CVD, CHD, and stroke. Our findings support the DGA recommendations for multiple healthy eating patterns.