title: Adherence to a healthy diet in relation to cardiovascular incidence and risk markers: evidence from the Caerphilly Prospective Study.
abstract: OBJECTIVE
  Epidemiological findings indicate that higher adherence to a healthy diet may lower cardiovascular disease (CVD) risk. The present study aimed to investigate whether adherence to a healthy diet, assessed by the Healthy Diet Indicator (HDI), Dietary Approaches to Stop Hypertension (DASH) score, and Alternative Healthy Eating Index 2010 (AHEI-2010), was associated with CVD incidence and risk markers.
  
  
  METHODS
  Included in the present analyses were data from 1867 middle-aged men, aged 56.7 ± 4.5 years at baseline, recruited into the Caerphilly Prospective Study. Adherence to a healthy diet was examined in relation to CVD, coronary heart disease (CHD), and stroke incidence (Cox regression), and risk markers (linear regression) with adjustment for relevant confounders.
  
  
  RESULTS
  The DASH score was inversely associated with CVD [hazard ratio (HR) 0.81; 95% confidence interval (CI) 0.66, 0.99], and stroke (HR 0.61; 95% CI 0.42, 0.88) incidence, but not with CHD after an average of 16.6 year follow-up, and with diastolic blood pressure, after 12 year follow-up. The AHEI-2010 was inversely associated with stroke (HR 0.66; 95% CI 0.42, 0.88) incidence, aortic pulse wave velocity, and C-reactive protein. The HDI was not associated with any single outcome.
  
  
  CONCLUSIONS
  Higher DASH and AHEI-2010 scores were associated with lower CVD and stroke risk, and favourable cardiovascular health outcomes, suggesting that encouraging middle-aged men to comply with the dietary recommendations for a healthy diet may have important implications for future vascular disease and population health.
authors.affiliation: Division of Human Nutrition, Wageningen University, P.O. Box 8129, 6700 EV, Wageningen, The Netherlands. elly.mertens@wur.nl.|Hugh Sinclair Unit of Human Nutrition, Department of Food and Nutritional Sciences and Institute for Cardiovascular and Metabolic Research (ICMR), University of Reading, Reading, RG6 6AP, UK. elly.mertens@wur.nl.
authors.forename: Elly
authors.initials: E
authors.lastname: Mertens
authors.affiliation: Hugh Sinclair Unit of Human Nutrition, Department of Food and Nutritional Sciences and Institute for Cardiovascular and Metabolic Research (ICMR), University of Reading, Reading, RG6 6AP, UK.|School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, LE11 3TU, UK.
authors.forename: Oonagh
authors.initials: O
authors.lastname: Markey
authors.affiliation: Division of Human Nutrition, Wageningen University, P.O. Box 8129, 6700 EV, Wageningen, The Netherlands.
authors.forename: Johanna M
authors.initials: JM
authors.lastname: Geleijnse
authors.affiliation: Hugh Sinclair Unit of Human Nutrition, Department of Food and Nutritional Sciences and Institute for Cardiovascular and Metabolic Research (ICMR), University of Reading, Reading, RG6 6AP, UK.
authors.forename: Julie A
authors.initials: JA
authors.lastname: Lovegrove
authors.affiliation: Food Production and Quality Division, School of Agriculture, Policy and Development, Faculty of Life Sciences, University of Reading, Reading, RG6 6AP, UK.
authors.forename: D Ian
authors.initials: DI
authors.lastname: Givens
mesh_terms: D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis; D002318:Cardiovascular Diseases / Q000097:blood / Q000453:epidemiology / Q000208:ethnology / Q000517:prevention & control*; D015331:Cohort Studies; D003327:Coronary Disease / Q000097:blood / Q000453:epidemiology / Q000208:ethnology / Q000517:prevention & control*; D003430:Cross-Sectional Studies; D000072001:Diet, Healthy / Q000208:ethnology; D000073601:Dietary Approaches To Stop Hypertension / Q000208:ethnology; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000208:ethnology; D016016:Proportional Hazards Models; D011446:Prospective Studies; D063177:Pulse Wave Analysis; D012307:Risk Factors; D020521:Stroke / Q000097:blood / Q000453:epidemiology / Q000208:ethnology / Q000517:prevention & control*; D014852:Wales / Q000453:epidemiology
chemical_list: D015415:Biomarkers; D002097:C-Reactive Protein
keywords: Alternative healthy eating index-2010; Aortic pulse wave velocity; Cardiovascular disease; Dietary adherence; Dietary approaches to stop hypertension score