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.