Abstract

Background: Recommendations to prevent risk of atherosclerotic cardiovascular disease (ASCVD) include reduced intakes of saturated fat, excess sodium and added sugars. Coronary artery calcium (CAC) develops over many years and is a strong predictor of future ASCVD but data regarding diet and CAC are limited. Methods: Participants from CARDIA with Y25 CAC measurement were included (n= 3,121). CAC presence (Agatston score >0) and incident ASCVD including coronary heart disease (CHD), heart failure (HF) and stroke were assessed from baseline (ages 18-30 y) over a 25 y follow up along with baseline diet assessed by diet history. Results: Mean (SD) age at baseline was 25.1 (3.6) y; 56.7% female, 46.7% black. Prevalence of CAC at Y25 was 28.4% and more likely male (64.7 % vs 34.8%) and white (58.7% vs 51.1%). There were 53 (3.0%) and 75 (5.7%) cases of ASCVD events in women and men respectively over 28.4 y (median: 27.1 y). Intake of saturated fat was not, but added sugars were associated with CAC presence. Intake of butter was seemingly protective for both CAC and ASCVD while sugar-sweetened beverages (SSBs) and sodium (borderline) were associated with incident ASCVD. SSBs were specifically associated with CHD, stroke, and HF. Conclusions: Dietary factors play an important role in development of ASCVD, but the same dietary factors may not necessarily be associated with CAC development. Adverse synergistic effects of sodium and added sugars may be especially related to CVD. Whether source of SFA e.g. meat/processed meat, vs dairy foods confers different ASCVD risks and whether added sugars directly or indirectly in SSB’s increase CAC and a CVD event, especially combined with high sodium intake, need further consideration.

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