Greater adherence to the portfolio diet is associated with lower cardiovascular disease risk in the Women’s Health Initiative study

Andrea J Glenn, Author, Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, CanadaDr. John SievenpiperPresenting Author

Kenneth Lo, Coauthor, Department of Applied Biology and Chemical Technology, The Hong Kong Polytechnic University, Hung Hom, Hong Kong, ChinaN/A

David JA Jenkins, Coauthor, Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, CanadaN/A

Beatrice A Boucher, Coauthor, Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, CanadaN/A

Anthony J Hanley, Coauthor, Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, CanadaN/A

Cyril WC Kendall, Coauthor, Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, CanadaN/A

JoAnn E Manson, Coauthor, Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USAN/A

Mara Z Vitolins, Coauthor, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina, USAN/A

Linda G Snetselaar, Coauthor, Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa, USAN/A

Simin Liu, Coauthor, Centre for Global Cardiometabolic Health, Department of Epidemiology, Brown University, Providence, Rhode Island, USAN/A

John L Sievenpiper, Coauthor, Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, CanadaN/A

The Portfolio Diet is a plant-based dietary pattern of a combination of recognized cholesterol-lowering foods that have been shown to improve a number of cardiovascular disease (CVD) risk factors, including low-density lipoprotein cholesterol, blood pressure, and C-reactive protein. However, no studies have assessed if following the Portfolio diet results in fewer CVD events, the leading cause of death for patients with diabetes.

We included 123,330 postmenopausal women from the Women’s Health Initiative (WHI) Observational Study and Clinical Trials (from 1993 to 2017) who were free of CVD at baseline. Adherence to the Portfolio diet was assessed using an a priori diet index based on 6 food categories (high in plant protein [soy & pulses], nuts, viscous fiber, plant

sterols and monounsaturated fat, and low in saturated fat) that were found to lower CVD risk factors in the Portfolio Diet trials. Adjusted hazard ratios (HRs) and 95% confidence intervals [CIs] for CVD were calculated using Cox regressions. We adjusted for CVD risk & lifestyle factors and potential confounders.

During 1,826,176 person-years of follow-up, we documented 13,365 total CVD cases, including 5,640 coronary heart disease (CHD) cases, 4,440 stroke cases, 1,907 heart failure (HF) cases, and 929 atrial fibrillation (AF) cases. Comparing the highest to the lowest quartile in the fully adjusted model, higher adherence to the Portfolio Diet was associated with a reduced risk of total CVD (HR=0.89 [95% CI 0.83-0.94]), CHD (0.86 [0.78-0.95]), and HF (0.83 [0.71-0.99]). No association was found with stroke (0.97 [0.87-1.08]) and AF (1.10 [0.87-1.38]). In postmenopausal women, higher adherence to the Portfolio Diet was inversely associated with total CVD, CHD, and HF but not stroke or AF.

These findings suggest that the Portfolio Diet may assist with CVD, CHD, and HF prevention, including in those with diabetes, and warrants further investigation. (WHI was funded by the NHLBI, NIH and USDHHS (HHSN268201600018C, HHSN268201600002C, HHSN26820 1600003C, and HHSN268201600004C). AJG was supported by the Banting & Best Diabetes Centre Tamarack Graduate Award in Diabetes Research, the Peterborough K.M. Hunter Charitable Foundation Graduate Award, and an Ontario Graduate Scholarship. JLS was funded by a Diabetes Canada Clinician Scientist Award).