Table 3.

Associations of the PURE healthy diet score with outcomes in a general population (PURE; n = 147 642)^a

All participants (n = 147 642)	Hazard ratio (95% CI)					P for trend	Hazard ratio (95% CI) per 20 percentile increment
	Q1 (n = 25 996)	Q2 (n = 34 952)	Q3 (n = 33 442)	Q4 (n = 28 133)	Q5 (n = 25 119)
Median score (range)	1 (0–1)	2	3	4	5 (5–6)
Total mortality
No. of deaths (%) (n = 10 076)	2936 (11.29)	2879 (8.24)	1932 (5.78)	1372 (4.88)	957 (3.81)
Incidence rate (events per 1000 person-years)	12.14	8.86	6.22	5.25	4.10
Age and sex adjusted	1.00	0.82 (0.78–0.86)	0.67 (0.63–0.72)	0.62 (0.58–0.67)	0.54 (0.50–0.59)	<0.0001	0.85(0.84–0.87)
Multivariable	1.00	0.89 (0.84–0.94)	0.79 (0.73–0.83)	0.75 (0.69–0.81)	0.70 (0.63–0.77)	<0.0001	0.91(0.89–0.93)
No history of CVD	1.00	0.89 (0.84–0.95)	0.78 (0.73–0.84)	0.76 (0.70–0.83)	0.71 (0.64–0.79)	<0.0001	0.92(0.89–0.94)
History of CVD	1.00	0.83 (0.69–1.00)	0.73 (0.60–0.89)	0.63 (0.50–0.79)	0.55 (0.42–0.72)	<0.0001	0.86(0.81–0.92)
Major CVD
No. of major CVD (%) (n = 8201)	1659 (6.38)	21 516.15)	1778 (5.32)	1451 (5.16)	1162 (4.63)
Incidence rate (events per 1000 person-years)	6.86	6.61	5.72	5.55	4.98
Age and sex adjusted	1.00	0.94 (0.88–1.00)	0.81 (0.76–0.87)	0.79 (0.73–0.85)	0.73 (0.67–0.80)	<0.0001	0.92(0.91–0.94)
Multivariable	1.00	0.96 (0.90–1.03)	0.84 (0.78–0.91)	0.82 (0.76–0.90)	0.82 (0.75–0.91)	<0.0001	0.94(0.92–0.97)
No history of CVD	1.00	0.96 (0.89–1.03)	0.84 (0.78–0.92)	0.85 (0.78–0.94)	0.84 (0.76–0.94)	0.0001	0.95(0.93–0.98)
History of CVD	1.00	0.96 (0.80–1.15)	0.81 (0.67–0.98)	0.71 (0.57–0.87)	0.70 (0.56–0.89)	0.0002	0.90(0.85–0.95)
MI
No. of MI (%) (n = 3806)	809 (3.11)	1080 (3.09)	810 (2.42)	598 (2.13)	509 (2.03)
Incidence rate (events per 1000 person-years)	3.34	3.32	2.60	2.29	2.18
Age and sex adjusted	1.00	0.98 (0.89–1.07)	0.84 (0.76–0.93)	0.76 (0.68–0.85)	0.75 (0.66–0.86)	<0.0001	0.92 (0.89–0.95)
Multivariable	1.00	1.01 (0.92–1.12)	0.89 (0.79–0.99)	0.82 (0.72–0.93)	0.86 (0.75–0.99)	0.0014	0.95 (0.92–0.98)
No history of CVD	1.00	1.03 (0.92–1.14)	0.91 (0.80–1.03)	0.87 (0.76–1.01)	0.92 (0.79–1.09)	0.0581	0.97 (0.93–1.00)
History of CVD	1.00	0.93 (0.73–1.18)	0.74 (0.57–0.97)	0.57 (0.42–0.77)	0.58 (0.42–0.81)	<0.0001	0.85 (0.79–0.92)
Stroke
No. of stroke (%) (n = 3925)	756 (2.91)	953 (2.73)	866 (2.59)	769 (2.73)	581 (2.31)
Incidence rate (events per 1000 person-years)	3.13	2.94	2.78	2.94	2.48
Age and sex adjusted	1.00	0.89 (0.81–0.98)	0.80 (0.72–0.88)	0.83 (0.75–0.93)	0.74 (0.65–0.83)	<0.0001	0.94 (0.91–0.96)
Multivariable	1.00	0.91 (0.82–1.01)	0.82 (0.73–0.91)	0.86 (0.76–0.97)	0.81 (0.71–0.93)	0.0034	0.95 (0.92–0.98)
No history of CVD	1.00	0.89 (0.79–0.99)	0.81 (0.71–0.91)	0.85 (0.75–0.97)	0.80 (0.69–0.93)	0.0059	0.95 (0.92–0.99)
History of CVD	1.00	1.04 (0.79–1.37)	0.91 (0.68–1.22)	0.94 (0.69–1.29)	0.88 (0.62–1.25)	0.3649	0.96 (0.89–1.04)
Composite of death or major CVD
No. of composite events (%) (n = 15 019)	3770 (14.50%)	4046 (11.58%)	3023 (9.04%)	2374 (8.44%)	1806 (7.19%)
Incidence rate (events per 1000 person-years)	15.59	12.45	9.72	9.08	7.73
Age and sex adjusted	1.00	0.86 (0.82–0.90)	0.73 (0.69–0.76)	0.70 (0.66–0.74)	0.64 (0.60–0.68)	<0.0001	0.89 (0.88–0.90)
Multivariable	1.00	0.91 (0.86–0.95)	0.79 (0.75–0.84)	0.79 (0.74–0.85)	0.78 (0.72–0.84)	<0.0001	0.93 (0.92–0.95)
No history of CVD	1.00	0.91 (0.86–0.96)	0.79 (0.75–0.84)	0.81 (0.75–0.86)	0.79 (0.73–0.86)	<0.0001	0.94 (0.92–0.96)
History of CVD	1.00	0.90 (0.77–1.04)	0.78 (0.67–0.92)	0.71 (0.60–0.85)	0.67 (0.55–0.82)	<0.0001	0.90 (0.86–0.94)

Age and sex adjusted: adjusted for age, sex, and centre (latter as random effect).

Multivariable models are adjusted for age, sex, study centre (random effect), waist-to-hip ratio, education level (primary or less; secondary; trade, college, or university), wealth index, urban or rural location, physical activity (low, < 600; moderate, 600–3000; high, > 3000 metabolic equivalent of task per minute per week), smoking status (never, former, or current), history of diabetes, use of statin or anti-hypertension medications, and total energy intake.