Abstract Body: Introduction: There is insufficient evidence on the impact of the environmentally sustainable diet proposed by the EAT-Lancet Commission on cardiovascular disease (CVD) and mortality in the US population.
Methods: Dietary intake was assessed by a 66-item food frequency questionnaire at visit 1 (1987-1989) and visit 3 (1993-1995) in the Atherosclerosis Risk in Communities (ARIC) study. The Planetary Health Diet Index (PHDI) was used to assess adherence to the EAT-Lancet reference diet. Incident CVD was a composite outcome of coronary heart disease (CHD), stroke, and heart failure. CVD mortality and all-cause mortality were defined as deaths based on International Classification of Diseases codes and National Death Index. Participants were followed until December 31, 2021. Associations between PHDI and CVD outcomes and mortality were analyzed using Cox proportional hazards models and adjusted for covariates.
Results: In 13,095 US adults, participants in the highest quintile of PHDI had a lower risk of total CVD (HR 0.84; 95%CI 0.77, 0.93; P-trend < 0.001) in the multivariable-adjusted model, compared with those in the lowest quintile (Figure). The inverse association was consistently observed across CVD subtypes (CHD: HR 0.83; 95%CI 0.72, 0.96; P-trend = 0.007; stroke: HR 0.77; 95%CI 0.65, 0.92; P-trend = 0.003; heart failure: HR 0.87; 95%CI 0.78, 0.98; P-trend = 0.01). Participants in the highest versus lowest quintile of PHDI had a 16% and 13% lower risk of CVD mortality and all-cause mortality, respectively (both P-trend < 0.005).
Conclusions: Higher adherence to PHDI was consistently associated with a lower risk of total CVD, CVD subtypes, CVD mortality, and all-cause mortality in a general population of US adults.