The relationship between the EAT-Lancet dietary pattern and risk of cardiovascular events in patients with established cardiovascular disease

PURPOSE: To reduce the risk of recurrent cardiovascular events in patients with established cardiovascular disease (CVD), guidelines recommend adopting a more plant-based diet. The EAT-Lancet diet, which focuses on plant-based foods, is associated with a lower risk of CVD in apparently healthy people. However, the relationship in patients with established CVD is unclear. Therefore, the aim of this research was to quantify the relationship between the EAT-Lancet Healthy Reference Diet (HRD) and risk of recurrent CVD in patients with established CVD.

METHODS: Patients with established CVD from the Utrecht Cardiovascular Cohort-Second Manifestations of ARTerial disease were studied. Dietary intake was measured using a food frequency questionnaire and the relationship between the EAT-Lancet HRD (score from 0 to 140 points) and non-fatal myocardial infarction and stroke was assessed using Cox regression adjusted for age, sex, educational background, lifestyle factors, and energy intake.

RESULTS: During a follow-up of 24,212 person-years 209 non-fatal vascular events occurred. The median score for the EAT-Lancet HRD was 57 out of 140 points (IQR: 41-68). After adjustment for confounders, a diet more in line with the EAT-Lancet HRD was associated with a lower risk of non-fatal vascular events (HR 0.87 (95% CI 0.79-0.96) per 10-point increase); stroke (HR 0.76 (95% CI 0.63-0.91) per 10-point increase); and a trend towards lower risk of myocardial infarction (HR 0.90 (95% CI 0.81-1.02) per 10-point increase).

CONCLUSION: In patients with established CVD, a dietary pattern more in line with the EAT-Lancet HRD is associated with a lower risk of non-fatal stroke and myocardial infarction.