Associations of Dietary Patterns and Micronutrients With Major Adverse Cardiovascular Events and Mortality Among Populations With Cardiovascular‐Kidney‐Metabolic Syndrome Stages 0–3: Results From Two Prospective Cohorts

ABSTRACT Following the recent proposal of cardiovascular‐kidney‐metabolic (CKM) syndrome by the American Heart Association (AHA), it remains uncertain whether plant‐based diets, inflammatory diets, or micronutrient intake are associated with major adverse cardiovascular events (MACE) and mortality in patients with CKM syndrome stages 0–3. The cohort study data were from the National Health and Nutrition Examination Survey (NHANES) 2005–2018 and the UK Biobank (UKB). We calculated scores of plant‐based diets, inflammatory diet in NHANES (dietary inflammatory index (DII) and alternative Mediterranean diet (AMED)), and UKB (AMED and Healthful Plant‐Based Diet Index (HPDI)), respectively. Multivariate Cox Regression models and restricted cubic spline analyses were used to assess the associations of plant‐based diets, inflammatory diets, and micronutrients with MACE and mortality among populations with CKM stages 0–3. Mediation analyses assessed the mediating effects of oxidative stress, phenotypic aging, and inflammatory markers. 82,222 and 16,842 participants were included in the analyses in UKB and NHANES, respectively. AMED and HPDI were significantly negatively associated with MACE and all‐cause mortality at higher tertiles, while DII was significantly positively associated. For each standard deviation increase in the scores of AMED and HPDI, the incidence of MACE decreased by 5%–7%. Higher intake of vitamins (Alpha/Beta‐carotene and vitamin C) and minerals (copper, iron, and magnesium) may reduce the incidence of MACE and mortality. Oxidative stress, phenotypic aging, and inflammatory markers partially mediated the associations (mediation ratio: 1.3%–29.5%). Adhering to plant‐based dietary patterns such as HPDI and AMED, reducing the intake of pro‐inflammatory red meat‐based diets, and ensuring adequate dietary intake of carotene and minerals may confer benefits for both metabolic and cardiovascular health.