Adherence to Multiple Dietary Patterns and Risk of Cardiovascular Disease in the UK Biobank cohort

Background

Diet quality is a major modifiable determinant of cardiovascular disease (CVD), yet most evidence is derived from studies evaluating single dietary patterns in isolation. It remains unclear whether associations with CVD are consistent across diverse dietary frameworks, including those incorporating environmental sustainability.

Methods

We analysed 198,072 UK Biobank participants with at least one 24-hour dietary assessment and free of CVD at baseline. Adherence to nine dietary pattern scores, including the Planetary Health Diet (PHD), DASH, AHEI, Mediterranean-based and plant-based diet indices, was quantified. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for incident CVD, myocardial infarction (MI), stroke, and heart failure (HF) per one-quartile higher adherence, adjusting for sociodemographic, lifestyle, and health factors.

Results

Over a median follow-up of 12.4 years, 54,417 incident CVD events occurred. Higher adherence to most dietary patterns was associated with lower risk of CVD. The strongest associations per quartile increase were observed for PHD (HR 0.94; 95% CI 0.93–0.95), DASH (0.95; 0.94–0.96), and AHEI (0.95; 0.94–0.96), while weaker associations were observed for reversed Unhealthful Plant-based Diet Index and Healthy Diet Indicator.

Conclusions

Higher adherence to multiple healthy dietary patterns was consistently associated with lower risk of CVD and its subtypes, with similar graded associations observed across diverse dietary indices. These findings suggest that shared features of dietary quality, rather than adherence to a specific dietary pattern, underpin cardiovascular benefit. The PHD showed associations comparable to established cardioprotective diets, supporting the integration of human and planetary health considerations in dietary recommendations.

Key messages

• Our findings suggest that shared features of dietary quality, rather than adherence to a specific dietary pattern, underpin cardiovascular benefit.

• The Planetary Health Diet shows associations to lower CVD risk comparable to established cardioprotective diets, supporting the integration of human and planetary health in dietary recommendations.