Adherence to the healthy eating index-2015 and other dietary patterns may reduce risk of cardiovascular disease, cardiovascular mortality, and all-cause mortality

Emily A. Hu, Lyn M. Steffen, Josef Coresh, Lawrence J. Appel, Casey M. Rebholz

Research output: Contribution to journalArticlepeer-review

124 Scopus citations


BACKGROUND: The Healthy Eating Index-2015 (HEI-2015) score measures adherence to recommendations from the 2015-2020 Dietary Guidelines for Americans. The HEI-2015 was altered from the HEI-2010 by reclassifying sources of dietary protein and replacing the empty calories component with 2 new components: saturated fats and added sugars.

OBJECTIVES: Our aim was to assess whether the HEI-2015 score, along with 3 other previously defined indices, were associated with incident cardiovascular disease (CVD), CVD mortality, and all-cause mortality.

METHODS: We conducted a prospective analysis of 12,413 participants aged 45-64 y (56% women) from the Atherosclerosis Risk in Communities (ARIC) Study. The HEI-2015, Alternative Healthy Eating Index-2010 (AHEI-2010), alternate Mediterranean (aMed) diet, and Dietary Approaches to Stop Hypertension Trial (DASH) scores were computed using the average dietary intakes of Visits 1 (1987-1989) and 3 (1993-1995). Incident CVD, CVD mortality, and all-cause mortality data were ascertained from baseline through 31 December, 2017. We used Cox proportional hazards models to estimate HRs and 95% CIs.

RESULTS: There were 4509 cases of incident CVD, 1722 cases of CVD mortality, and 5747 cases of all-cause mortality over a median of 24-25 y of follow-up. Compared with participants in the lowest quintile of HEI-2015, participants in the highest quintile had a 16% lower risk of incident CVD (HR: 0.84; 95% CI: 0.76-0.93; P-trend < 0.001), 32% lower risk of CVD mortality (HR: 0.68; 95% CI: 0.58-0.80; P-trend < 0.001), and 18% lower risk of all-cause mortality (HR: 0.82; 95% CI: 0.75-0.89; P-trend < 0.001) after adjusting for demographic and lifestyle covariates. There were similar protective associations for AHEI-2010, aMed, and DASH scores, and no significant interactions by race.

CONCLUSIONS: Higher adherence to the 2015-2020 Dietary Guidelines for Americans was associated with lower risks of incident CVD, CVD mortality, and all-cause mortality among US adults.

Original languageEnglish (US)
Pages (from-to)312-321
Number of pages10
JournalJournal of Nutrition
Issue number2
StatePublished - Feb 1 2020

Bibliographical note

Publisher Copyright:
Copyright © American Society for Nutrition 2019. All rights reserved.


  • ARIC
  • Cardiovascular disease
  • Dietary pattern
  • Dietary score
  • Mortality
  • Prospective Studies
  • Cardiovascular Diseases/epidemiology
  • Humans
  • Middle Aged
  • Male
  • Diet, Healthy
  • Cause of Death
  • Guideline Adherence
  • Female

PubMed: MeSH publication types

  • Journal Article
  • Research Support, N.I.H., Extramural


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