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. Author manuscript; available in PMC: 2021 Nov 10.
Published in final edited form as: J Am Coll Cardiol. 2020 Nov 10;76(19):2181–2193. doi: 10.1016/j.jacc.2020.09.535

TABLE 2.

HR (95% CI) of CVD Risk by Quintile of EDIP Scores in the NHS, NHSII, and HPFS

HR (95% CI) Comparing Higher to the Lowest Quintiles of EDIP Scores*
p Trend
Quintile 1 Quintile 2 Quintile 3 Quintile 4 Quintile 5
Total CVD: fatal CHD + nonfatal MI + fatal and nonfatal stroke
 NHS
  Cases/PY 1,148/426,929 1,327/431,816 1,527/423,576 1,530/413,485 1,694/378,490
  Age adjusted 1 (ref.) 1.07 (0.99–1.16) 1.25 (1.16–1.35) 1.31 (1.21–1.41) 1.76 (1.63–1.89) <0.001
  Multivariable model 1 1 (ref.) 1.09 (1.01–1.18) 1.27 (1.18–1.37) 1.32 (1.22–1.43) 1.72 (1.60–1.86) <0.001
  Multivariable model 2 1 (ref.) 1.06 (0.98–1.15) 1.18 (1.09–1.27) 1.17 (1.08–1.27) 1.40 (1.30–1.52) <0.001
 NHSII
  Cases/PY 190/427,266 244/438,049 257/439,294 291/434,484 377/418,622
  Age adjusted 1 (ref.) 1.30 (1.07–1.57) 1.38 (1.15–1.67) 1.62 (1.35–1.95) 2.21 (1.86–2.64) <0.001
  Multivariable model 1 1 (ref.) 1.30 (1.07–1.57) 1.36 (1.12–1.64) 1.55 (1.29–1.86) 1.98 (1.66–2.37) <0.001
  Multivariable model 2 1 (ref.) 1.26 (1.04–1.53) 1.27 (1.05–1.54) 1.36 (1.12–1.63) 1.55 (1.29–1.86) <0.001
 HPFS
  Cases/PY 1,207/228,292 1,392/220,083 1,468/210,506 1,546/203,806 1,639/196,820
  Age adjusted 1 (ref.) 1.08 (1.00–1.17) 1.14 (1.05–1.23) 1.25 (1.15–1.35) 1.49 (1.38–1.60) <0.001
  Multivariable model 1 1 (ref.) 1.08 (1.00–1.17) 1.13 (1.05–1.22) 1.23 (1.13–1.32) 1.42 (1.32–1.54) <0.001
  Multivariable model 2 1 (ref.) 1.07 (0.99–1.16) 1.11 (1.03–1.20) 1.18 (1.09–1.28) 1.34 (1.24–1.44) <0.001
 Combined
  Age adjusted 1 (ref.) 1.09 (1.04–1.15) 1.21 (1.15–1.27) 1.30 (1.23–1.37) 1.66 (1.58–1.75) <0.001
  Multivariable model 1 1 (ref.) 1.10 (1.04–1.16) 1.21 (1.15–1.28) 1.29 (1.23–1.36) 1.60 (1.52–1.68) <0.001
  Multivariable model 2 1 (ref.) 1.08 (1.02–1.14) 1.15 (1.09–1.22) 1.19 (1.13–1.26) 1.38 (1.31–1.46) <0.001
Total CHD: fatal CHD + nonfatal MI
 NHS
  Cases/PY 566/427,408 653/432,382 821/424,221 804/414,106 955/379,116
  Age adjusted 1 (ref.) 1.08 (0.97–1.21) 1.37 (1.23–1.53) 1.40 (1.26–1.56) 2.00 (1.80–2.22) <0.001
  Multivariable model 1 1 (ref.) 1.11 (0.99–1.24) 1.41 (1.26–1.57) 1.44 (1.29–1.61) 1.98 (1.78–2.20) <0.001
  Multivariable model 2 1 (ref.) 1.07 (0.95–1.20) 1.28 (1.15–1.42) 1.24 (1.11–1.38) 1.53 (1.37–1.71) <0.001
 NHSII
  Cases/PY 96/427,354 125/438,165 127/439,422 145/434,623 202/418,795
  Age adjusted 1 (ref.) 1.34 (1.02–1.74) 1.39 (1.06–1.81) 1.63 (1.26–2.12) 2.40 (1.88–3.06) <0.001
  Multivariable model 1 1 (ref.) 1.33 (1.02–1.74) 1.34 (1.03–1.76) 1.54 (1.19–2.01) 2.07 (1.61–2.65) <0.001
  Multivariable model 2 1 (ref.) 1.29 (0.99–1.69) 1.25 (0.96–1.64) 1.31 (1.01–1.71) 1.53 (1.18–1.97) 0.002
 HPFS
  Cases/PY 852/228,679 996/220,495 1071/210,867 1,147/204,173 1,234/197,197
  Age adjusted 1 (ref.) 1.11 (1.01–1.21) 1.17 (1.07–1.29) 1.31 (1.20–1.44) 1.59 (1.45–1.74) <0.001
  Multivariable model 1 1 (ref.) 1.10 (1.00–1.21) 1.16 (1.06–1.27) 1.28 (1.17–1.40) 1.50 (1.37–1.64) <0.001
  Multivariable model 2 1 (ref.) 1.09 (1.00–1.20) 1.14 (1.04–1.25) 1.23 (1.12–1.35) 1.40 (1.28–1.53) <0.001
 Combined
  Age adjusted 1 (ref.) 1.11 (1.04–1.19) 1.26 (1.18–1.35) 1.36 (1.28–1.46) 1.79 (1.68–1.91) <0.001
  Multivariable model 1 1 (ref.) 1.12 (1.04–1.20) 1.26 (1.18–1.35) 1.35 (1.27–1.45) 1.71 (1.60–1.82) <0.001
  Multivariable model 2 1 (ref.) 1.10 (1.02–1.17) 1.20 (1.12–1.28) 1.24 (1.16–1.32) 1.46 (1.36–1.56) <0.001
Stroke: fatal and nonfatal stroke
 NHS
  Cases/PY 594/427,332 688/432,277 726/424,135 749/413,985 756/379,056
  Age adjusted 1 (ref.) 1.07 (0.96–1.19) 1.15 (1.03–1.28) 1.22 (1.10–1.36) 1.52 (1.36–1.69) <0.001
  Multivariable model 1 1 (ref.) 1.07 (0.96–1.19) 1.15 (1.03–1.28) 1.22 (1.10–1.36) 1.48 (1.33–1.65) <0.001
  Multivariable model 2 1 (ref.) 1.05 (0.94–1.17) 1.08 (0.97–1.21) 1.12 (1.01–1.25) 1.28 (1.14–1.43) <0.001
 NHSII
  Cases/PY 94/427,350 119/438,165 130/439,391 148/434,606 177/418,775
  Age adjusted 1 (ref.) 1.26 (0.96–1.65) 1.38 (1.05–1.80) 1.63 (1.25–2.11) 2.05 (1.60–2.64) <0.001
  Multivariable model 1 1 (ref.) 1.26 (0.96–1.65) 1.36 (1.04–1.78) 1.58 (1.22–2.05) 1.91 (1.48–2.47) <0.001
  Multivariable model 2 1 (ref.) 1.23 (0.94–1.61) 1.29 (0.99–1.69) 1.43 (1.10–1.86) 1.59 (1.22–2.06) <0.001
 HPFS
  Cases/PY 361/228,790 401/220,703 401/211,118 410/204,418 420/197,464
  Age adjusted 1 (ref.) 1.02 (0.88–1.18) 1.05 (0.91–1.21) 1.10 (0.95–1.27) 1.26 (1.09–1.46) <0.001
  Multivariable model 1 1 (ref.) 1.02 (0.89–1.18) 1.06 (0.92–1.23) 1.11 (0.96–1.28) 1.26 (1.09–1.46) <0.001
  Multivariable model 2 1 (ref.) 1.02 (0.88–1.18) 1.05 (0.91–1.22) 1.08 (0.93–1.24) 1.19 (1.03–1.38) 0.01
 Combined
  Age adjusted 1 (ref.) 1.07 (0.98–1.16) 1.13 (1.04–1.23) 1.22 (1.12–1.32) 1.48 (1.36–1.60) <0.001
  Multivariable model 1 1 (ref.) 1.07 (0.98–1.16) 1.14 (1.05–1.24) 1.21 (1.12–1.32) 1.44 (1.33–1.57) <0.001
  Multivariable model 2 1 (ref.) 1.06 (0.97–1.15) 1.09 (1.00–1.19) 1.13 (1.04–1.23) 1.28 (1.17–1.39) <0.001
*

The EDIP scores were calculated based on cumulatively averaged dietary intakes from all preceding food frequency questionnaires up to each follow-up interval. EDIP scores were adjusted for total energy intake using a residual method. Lower scores indicate anti-inflammatory diets, and higher scores indicate proinflammatory diets.

The multivariable models were adjusted for age (months), race (White, non-White), smoking (never; past; current: 1–14,15–24, ≥25 cigarettes/day), menopausal status and post-menopausal hormone use (premenopausal, never/past users of hormone therapy, and current users of hormone therapy; only in NHS and NHSII), multivitamin use (no, yes), regular aspirin use (no, yes), regular use of other anti-inflammatory medications (no, yes), physical activity (<3, 3–9, 9–18,18–27, 27–42, ≥42 metabolic equivalents/week), and family history of myocardial infarction (no, yes).

Models were further adjusted for hypercholesterolemia (no, yes), hypertension (no, yes), diabetes (no, yes), and body mass index (continuous). Results from the 3 cohorts were pooled using a fixed-effect meta-analysis. In the fully adjusted model, p-heterogeneity testing association difference across the 3 cohorts was 0.98 for CVD, 0.60 for CHD, and 0.69 for stroke.

CHD = coronary heart disease; CI = confidence interval; CVD = cardiovascular disease; HR = hazard ratio; MI = myocardial infarction; PY = person-years; ref. = reference; other abbreviations as in Table 1.