title: Diet quality and the risk of cardiovascular disease: the Women's Health Initiative (WHI).
abstract: BACKGROUND
  The association between diet quality and risk of incident cardiovascular disease (CVD) or heart failure (HF) in postmenopausal women is uncertain.
  
  
  OBJECTIVE
  This study aimed to determine whether a conventional index [Alternate Healthy Eating Index (AHEI)] or a novel index [Women's Health Initiative (WHI) Dietary Modification Index (DMI)] of diet quality was associated with the risk of incident CVD or HF in the WHI Observational Study (WHI-OS).
  
  
  METHODS
  The WHI-OS is an observational cohort study of 93,676 women aged 50-79 y of diverse ethnicity and backgrounds followed for an average of 10.0 y for CVD events. The individual components of the AHEI and DMI were determined from the baseline WHI food-frequency questionnaire. Incident CVD was a composite of nonfatal myocardial infarction, coronary heart disease death, stroke, coronary revascularization, and incident HF. The association between AHEI or DMI and incident CVD or incident HF was determined by using Cox models adjusted for traditional CVD and HF risk factors.
  
  
  RESULTS
  Women with a DMI in the highest quintile had hazard ratios (HRs) of 0.88 (95% CI: 0.80, 0.95) and 0.91 (95% CI: 0.78, 1.06) for incident CVD and HF, respectively. Women with an AHEI in the highest quintile had HRs of 0.77 (95% CI: 0.70, 0.84) and 0.70 (95% CI: 0.59, 0.82) for incident CVD and HF, respectively.
  
  
  CONCLUSIONS
  Overall, adherence to current nutrient guidelines (as indexed by the DMI) are associated with lower total CVD risk, and additional dietary factors (as indexed by the AHEI) were associated with a lower risk of CVD and HF.
authors: Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.
authors: Rashad J
authors: RJ
authors: Belin
authors: Philip
authors: P
authors: Greenland
authors: Matthew
authors: M
authors: Allison
authors: Lisa
authors: L
authors: Martin
authors: James M
authors: JM
authors: Shikany
authors: Joseph
authors: J
authors: Larson
authors: Lesley
authors: L
authors: Tinker
authors: Barbara V
authors: BV
authors: Howard
authors: Donald
authors: D
authors: Lloyd-Jones
authors: Linda
authors: L
authors: Van Horn
references: Arch Intern Med. 2004 Nov 8;164(20):2235-40
references: 15534160
references: JAMA. 2002 Nov 27;288(20):2569-78
references: 12444864
references: Circulation. 1999 Feb 16;99(6):779-85
references: 9989963
references: JAMA. 2006 Feb 8;295(6):655-66
references: 16467234
references: N Engl J Med. 1997 Apr 17;336(16):1117-24
references: 9099655
references: Am J Clin Nutr. 2000 Oct;72(4):912-21
references: 11010931
references: Circulation. 2006 Jul 4;114(1):82-96
references: 16785338
references: N Engl J Med. 1997 Nov 20;337(21):1491-9
references: 9366580
references: Arch Intern Med. 1997 Oct 27;157(19):2249-58
references: 9343002
references: Circulation. 2001 Apr 3;103(13):1823-5
references: 11282918
references: Ann Epidemiol. 1999 Apr;9(3):178-87
references: 10192650
references: Ann Epidemiol. 2003 Oct;13(9 Suppl):S122-8
references: 14575944
references: Ann Epidemiol. 2003 Oct;13(9 Suppl):S107-21
references: 14575943
references: Stroke. 2004 Sep;35(9):2014-9
references: 15232120
references: Circulation. 2009 Jan 27;119(3):e21-181
references: 19075105
references: Am J Clin Nutr. 2002 Dec;76(6):1261-71
references: 12450892
references: Am J Epidemiol. 2008 May 15;167(10):1247-59
references: 18344516
references: Public Health Nutr. 2006 Feb;9(1A):152-7
references: 16512963
references: Am J Clin Nutr. 1999 Aug;70(2):221-7
references: 10426698
references: JAMA. 1999 Oct 6;282(13):1233-9
references: 10517425
references: Arch Intern Med. 2001 Aug 13-27;161(15):1857-62
references: 11493127