Dietary Approaches to Stop Hypertension Score Trajectories From Early to Middle Adulthood and Coronary Artery Calcium Progression in Middle Age

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Background The Dietary Approaches to Stop Hypertension (DASH) diet reduces blood pressure and cardiovascular disease risk, but its impact on later coronary artery calcium (CAC) progression is unclear. This study aimed to identify DASH score trajectories from early to middle adulthood and assess their association with CAC progression in middle age, exploring the potential mediating factors. Methods We conducted a prospective analysis of 2238 Black and White adults who were aged 18 to 30 years at CARDIA (Coronary Artery Risk Development in Young Adults) baseline and were followed from study year 20 to year 25. DASH score trajectories from early to middle adulthood were determined using latent class analysis. The primary end point was CAC progression, a validated measure of plaque progression, defined as a >2.5 square root increase in CAC score between years 20 and 25. Results Two distinct DASH score trajectories were identified: the low‐increasing and high‐decreasing trajectories. In the fully adjusted model, participants in the high‐decreasing trajectory had a 21% lower risk of CAC progression compared with those in the low‐increasing trajectory (hazard ratio, 0.79 [95% CI, 0.65–0.98]; P =0.028). The association was partially mediated by diastolic blood pressure, insulin, uric acid, and lipid profiles. Conclusions DASH score trajectories vary from early to middle adulthood. Maintaining high adherence to the DASH diet from early to middle adulthood is associated with reduced CAC progression in middle age, partially mediated by cardiometabolic risk factors. These findings support the importance of long‐term adherence to a healthy dietary pattern for cardiovascular disease primary prevention. REGISTRATION: URL: https://www.clinicaltrials.gov ; unique identifier: NCT00005130.

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