Healthy Eating for the Planet, Cardiovascular Health, and Longevity: An Observational Study

There is limited evidence on the impact of the environmentally sustainable diet proposed by the EAT-Lancet Commission on cardiovascular disease (CVD) and death. We aimed to investigate the association between the EAT-Lancet diet and cardiovascular morbidity and death in the United States.

We included 13 444 US middle-aged adults from the ARIC (Atherosclerosis Risk in Communities) study who were free of CVD at baseline, with dietary data collected at visit 1 (1987-1989) and visit 3 (1993-1995). We assessed adherence to the EAT-Lancet reference diet using the Planetary Health Diet Index (PHDI), which ranged from 0 to 135, with higher scores indicating greater adherence. Associations between PHDI and risk of CVD (a composite outcome of coronary heart disease, stroke, and heart failure), CVD deaths, and total deaths were evaluated using Cox proportional hazards regression.

After a median follow-up of 29 years, we documented 5074 total CVD events, 2512 deaths caused by CVD, and 8436 total deaths. The mean PHDI score was 76 (range, 30-113). Participants in the highest versus lowest quintile of PHDI had a 13% lower risk of total CVD (P-trend <0.001). A 20-point higher PHDI was associated with 13%, 16%, and 9% lower risk of coronary heart disease, stroke, and heart failure, respectively (all P≤0.02). It was also associated with 13% and 10% lower risk of CVD death and all-cause death, respectively (both P≤0.003).

A dietary pattern that promotes planetary health was associated with a lower risk of CVD morbidity and death in a general population.