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Dietary Approaches to Stop Hypertension Score Trajectories From Early to Middle Adulthood and Coronary Artery Calcium

Xiong-Zhi Li1, Zhuo-Chao Xiong1, Xin-Yi Wang1

  • 1Department of Cardiology Shanghai East Hospital, Tongji University School of Medicine Shanghai 200120 China.

Journal of the American Heart Association
|August 7, 2026
PubMed

Insights

Maintaining a high adherence to the Dietary Approaches to Stop Hypertension (DASH) diet from early to middle adulthood significantly reduces coronary artery calcium (CAC) progression. This dietary pattern is linked to better cardiovascular health outcomes in middle age.

Area of Science:

  • Cardiovascular disease research
  • Nutritional science
  • Public health

Background:

  • The Dietary Approaches to Stop Hypertension (DASH) diet is known to lower blood pressure and cardiovascular disease (CVD) risk.
  • However, its long-term effect on coronary artery calcium (CAC) progression from early adulthood to middle age remains under investigation.

Purpose of the Study:

  • To identify distinct trajectories of DASH diet adherence from early to middle adulthood.
  • To examine the association between these trajectories and CAC progression.
  • To explore potential mediating factors in this relationship.

Main Methods:

  • Prospective analysis of 2238 adults (Black and White) from the Coronary Artery Risk Development in Young Adults (CARDIA) study.
  • Latent class analysis used to define DASH score trajectories from age 18-30 to age 20-25.
  • CAC progression defined as an increase >2.5 square root increase in CAC score between study years 20 and 25.

Main Results:

  • Two DASH score trajectories were identified: low-increasing and high-decreasing.
  • Individuals in the high-decreasing trajectory showed a 21% lower risk of CAC progression compared to the low-increasing group (HR, 0.79; P=0.028).
  • This association was partially mediated by diastolic blood pressure, insulin, uric acid, and lipid profiles.

Conclusions:

  • DASH diet adherence trajectories differ significantly across adulthood.
  • Sustained high adherence to the DASH diet is associated with reduced CAC progression in middle age.
  • Long-term adherence to healthy dietary patterns is crucial for primary prevention of cardiovascular disease, partly through cardiometabolic risk factor mediation.
Abstract

Keywords:
cardiometabolic riskcardiovascular diseasecoronary artery calciumdietdietary approaches to stop hypertensionprimary prevention

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