Simple Nutrient-Based Rules vs. a Nutritionally Rich Plant-Centered Diet in Prediction of Future Coronary Heart Disease and Stroke: Prospective Observational Study in the US

Yuni Choi, Dan D Gallaher, Karianne Svendsen, Katie A. Meyer, Lyn M. Steffen, Pamela Schreiner, James M. Shikany, Jamal S. Rana, Daniel Duprez, David Jacobs

Research output: Contribution to journalArticlepeer-review

7 Scopus citations


To better understand nutrition paradigm shift from nutrients to foods and dietary patterns, we compared associations of a nutrient-based blood cholesterol-lowering diet vs. a food-based plant-centered diet with risk of coronary heart disease (CHD) and stroke. Participants were 4701 adults aged 18–30 years and free of cardiovascular disease at baseline, followed for clinical events from 1985 and 86 to 2018. A plant-centered diet was represented by higher A Priori Diet Quality Score (APDQS). A blood cholesterol-lowering diet was represented by lower Keys Score. Proportional hazards regression was used to calculate hazard ratios (HR). Higher APDQS showed a nutrient-dense composition that is low in saturated fat but high in fiber, vitamins and minerals. Keys Score and APDQS changes were each inversely associated with concurrent plasma low-density lipoprotein cholesterol (LDL-C) change. Over follow-up, 116 CHD and 80 stroke events occurred. LDL-C predicted CHD, but not stroke. APDQS, but not Keys Score, predicted lower risk of CHD and of stroke. Adjusted HRs (95% CIs) for each 1-SD higher APDQS were 0.73 (0.55–0.96) for CHD and 0.70 (0.50–0.99) for stroke. Neither low dietary fat nor low dietary carbohydrate predicted these events. Our findings support the ongoing shift in diet messages for cardiovascular prevention.

Original languageEnglish (US)
Article number469
Issue number3
StatePublished - Feb 1 2022

Bibliographical note

Funding Information:
Funding: The Coronary Artery Risk Development in Young Adults Study (CARDIA) is conducted and supported by the National Heart, Lung, and Blood Institute (NHLBI) in collaboration with the University of Alabama at Birmingham (HHSN268201800005I & HHSN268201800007I), Northwestern University (HHSN268201800003I), University of Minnesota (HHSN268201800006I), and Kaiser Foundation Research Institute (HHSN268201800004I). This manuscript has been reviewed by CARDIA for scientific content. The sponsor, NHLBI has a representative on the Steering Committee of CARDIA and participated in study design, data collection, and scientific review of this paper. The sponsor had no role in data analysis, data interpretation, or writing of this report.

Funding Information:
Conflicts of Interest: D.D.G. is a paid member of the Nutrition Advisory Council for the California Prune Board. L.M.S. received a grant ending February 2020 with Dairy Management about dairy products and a grant from the California Walnut Commission. K.A.M. received a grant from the Balchem Corporation. The funding organizations listed above are not related to this article. The rest of authors declare no conflict of interest.

Publisher Copyright:
© 2022 by the authors. Licensee MDPI, Basel, Switzerland.


  • Cholesterol-lowering diets
  • Coronary heart disease
  • Plant-centered diets
  • Prospective study
  • Simple nutrient-based rules
  • Stroke


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