Adherence to a sustainable diet, measured via the EAT-Lancet Index, predicts incident short-term and long-term cardiovascular disease incidence: the ATTICA study (2002-2022)

Abstract Background/Introduction The World Heart Federation has estimated that air pollution was the second most fatal modifiable risk factor for cardiovascular disease (CVD), causing approximately 5 million CVD deaths in 2021. Diets and food systems can affect the environment; however, research scarcely focuses on the association between planet-healthy dietary habits and CVD risk. Purpose The purpose of this study was to evaluate the adherence to a sustainable diet and CVD incidence during 20 years of follow-up. Methods Participants initially free-of-CVD from the ATTICA study were used (n=1,958). CVD events were assessed at baseline and at all follow-ups (i.e., 2002, 2012, 2022) according to WHO-ICD-10. Adherence to a sustainable diet was assessed via the EAT-Lancet Index (EAT-LI) (Education and Agriculture Together-EAT) (range: 0-42) based on the published algorithm. Results CVD incidence was 16.2% (n=317 incident cases) at 10-years and 35.3% (n=691 incident cases) at 20-years. Mean EAT-LI was: 17.3 (6.7) for the total sample. EAT-LI was lower in those that had a CVD event during the follow-up, i.e., EAT-LI: 10.5 (6.3) vs 18.5 (5.9) at 10-years (p<0.001) and 10.9 (6.4) vs 20.8 (3.8) at 20-years (p<0.001), in participants with and without a CVD event, respectively. In multi-adjusted analyses, adjusted for age, sex, body mass index trajectories, lifestyle trajectories, and clinical factors (diabetes, hypercholesterolemia, hypertension), higher adherence to a sustainable diet was inversely associated with CVD risk at a short-term and a long-term period (i.e., at 10 and 20 years). Specifically, per 1/42 increase in the EAT-Lancet index, CVD risk was reduced by 11% [Hazard ratio-HR: 0.89, 95%Confidence Interval: 0.86-0.93] and by 16% [HR: 0.84, 95%CI: 0.80-0.89] at 10 and 20 years, respectively. Conclusion Future guidelines for CVD prevention should take into account the sustainable nature of dietary habits, to efficiently nourish the growing world population, and concomitantly protect heart and planet health.