Abstract
Introduction: Suboptimal diet is a leading risk factor for cardiovascular disease (CVD). Yet, the relationship between diet quality and lifetime CVD risk, and whether it differs by age, are unclear. Methods: Diet data from 10 US prospective cohorts were harmonized according to a standard protocol. Three diet quality indices were calculated within each cohort: Dietary Approaches to Stop Hypertension (DASH) diet, alternate Healthy Eating Index 2010 (aHEI-2010), and alternate Mediterranean (aMED) diet. CVD included coronary heart disease, stroke and heart failure. Study sample was divided into younger (<40 years old), middle-aged (40-60) and older (>60) groups based on age at the first dietary assessment. Cumulative CVD risk according to 5-year interval was estimated using modified Kaplan-Meier analysis, adjusting for competing risk of death. Multivariable proportional hazards regression was applied to determine the association between the three diet quality indices and CVD by sex and age. Results: A total of 129,892 participants with 1,603,199 person years of follow-up were analyzed. The adjusted cumulative CVD risk was lower in younger and middle-aged men and all women who had higher DASH score (Figure 1). Age modified the diet-CVD association in both men and women (P <0.0005). Compared to the lowest DASH score quintile (poorest diet), the adjusted hazard ratio (HR) for CVD decreased with increasing quintile of diet quality. The HR for the highest quintile was 0.41 (95% CI: 0.20-0.87) in younger men, 0.97 (0.82-1.16) in middle-aged men, 1.03 (0.89-1.19) in older men, 0.47 (0.21-1.05) in younger women, 0.73 (0.63-0.84) in middle-aged women, and 0.82 (0.76-0.88) in older women. Results were similar for aMED and aHEI-2010 score. Conclusions: Better diet quality is associated with lower lifetime CVD risk in all women and men except older men. Stronger inverse diet quality-CVD association in younger than middle-aged and older adults suggests that relative benefits of a healthy diet for CVD risk reduction may be greater at younger ages.
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