Table 4.
HR (95% CI) of Incident CVD Outcomes (Y20‐Y32) According to Quintiles of the 13‐year Change in APDQS*
| Quintile 1 | Quintile 2 | Quintile 3 | Quintile 4 | Quintile 5 | Each 1‐SD increment (13‐point) | P for Trend† | |
|---|---|---|---|---|---|---|---|
| CVD | |||||||
| 13‐year change in APDQS (median) | −9 | −1 | 4 | 9 | 17 | ||
| Unadjusted cumulative incidence % (n/N) | 5.6 (31/559) | 4.2 (22/522) | 2.5 (13/522) | 4 (21/528) | 2.2 (11/490) | ||
| Model 1‡ | 1 (ref) | 0.74 (0.43–1.3) | 0.42 (0.22–0.81) | 0.63 (0.35–1.12) | 0.33 (0.16–0.68) | 0.69 (0.52–0.90) | 0.007 |
| Model 2§ | 1 (ref) | 0.81 (0.46–1.43) | 0.48 (0.25–0.93) | 0.74 (0.41–1.33) | 0.39 (0.19–0.81) | 0.75 (0.57–1.00) | 0.048 |
| Model 3|| | 1 (ref) | 0.86 (0.49–1.5) | 0.47 (0.24–0.92) | 0.75 (0.41–1.35) | 0.36 (0.17–0.75) | 0.73 (0.56–0.97) | 0.028 |
| CHD | |||||||
| 13‐year change in APDQS (median) | −9 | −1 | 4 | 9 | 17 | ||
| Unadjusted cumulative incidence % (n/N) | 2.9 (16/559) | 2.1 (11/522) | 1.3 (7/522) | 2.1 (11/528) | 0.6 (3/490) | ||
| Model 1‡ | 1 (ref) | 0.71 (0.32–1.54) | 0.43 (0.17–1.06) | 0.66 (0.30–1.47) | 0.18 (0.05–0.64) | 0.64 (0.43–0.95) | 0.027 |
| Model 2§ | 1 (ref) | 0.79 (0.36–1.74) | 0.50 (0.20–1.24) | 0.75 (0.33–1.69) | 0.21 (0.06–0.75) | 0.70 (0.47–1.05) | 0.084 |
| Model 3|| | 1 (ref) | 0.83 (0.37–1.82) | 0.53 (0.21–1.32) | 0.77 (0.34–1.75) | 0.20 (0.06–0.72) | 0.69 (0.46–1.04) | 0.076 |
| Hypertensive‐related CVD | |||||||
| 13‐year change in APDQS (median) | −9 | −1 | 4 | 9 | 17 | ||
| Unadjusted cumulative incidence % (n/N) | 5.0 (28/557) | 2.9 (15/521) | 1.3 (7/522) | 2.5 (13/527) | 2.0 (10/490) | ||
| Model 1‡ | 1 (ref) | 0.54 (0.29–1.03) | 0.23 (0.10–0.54) | 0.38 (0.19–0.76) | 0.29 (0.14–0.64) | 0.58 (0.42–0.79) | <0.001 |
| Model 2+ | 1 (ref) | 0.58 (0.31–1.11) | 0.26 (0.11–0.61) | 0.44 (0.22–0.89) | 0.34 (0.16–0.74) | 0.63 (0.45–0.86) | 0.004 |
| Model 3|| | 1 (ref) | 0.60 (0.32–1.15) | 0.23 (0.10–0.54) | 0.44 (0.22–0.90) | 0.31 (0.14–0.68) | 0.61 (0.44–0.84) | 0.003 |
APDQS indicates A Priori Diet Quality Score; CHD, coronary heart disease; CVD, cardiovascular disease; and HR, hazard ratio.
The 13‐year change in APDQS ( year 20 value minus year 7 value) was used to predict events occurred between year 20 and year 32.
Statistical significance was estimated by modelling APDQS as a continuous variable in the model.
Model 1: year 7 APDQS, year 0 age, sex, race (White or Black), total energy intake (year 7 and 13‐year change), and maximal educational attainment.
Model 2: model 1+parental history of CVD (yes vs no), year 7 smoking status (never, former, and current), and physical activity level (year 7 and 13‐year change).
Model 3: model 2+hypertension (yes vs no), diabetes mellitus (yes vs no), dyslipidemia (yes vs no), and body mass index (continuous). The cumulative data through year 20 were used.