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Recruitment and baseline data collection have been previously reported. 19, 20, 21 Briefly, between 19, postmenopausal women aged 50 to 79 years were recruited into clinical trials or an observational study (OS) (n=161 808). The design and methods of the WHI have been published elsewhere.
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Here, for the first time, we have evaluated the association of a Portfolio Diet score with CVD outcomes in the WHI (Women's Health Initiative). We have therefore developed a scoring system to measure adherence to the Portfolio Diet for use in these study designs.
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Analyses of established observational studies may be helpful in assessing the long‐term effectiveness of the Portfolio Diet.
#PORT FOLIO DIET TRIAL#
Although conducting a long‐term randomized trial with CVD as the primary outcome would be preferable, this type of trial is not yet feasible. The individual components of the Portfolio Diet have been found to be associated with lower incidence of CVD events in prospective cohorts, 13, 14, 15, 16, 17 and 2 components of the diet (nuts and extra virgin olive oil) were shown to reduce major vascular events in the landmark PREDIMED (Prevención con Dieta Mediterránea) trial compared to a low saturated fat 18 however, the additive/combined effects of the Portfolio Diet components have not been assessed with incident CVD. 12Ĭurrently, it is not known if these beneficial effects of the diet translate into lower risk of clinical CVD events. 8 These benefits have been recognized by CVD and diabetes mellitus clinical practice guidelines internationally, including those of the Canadian Cardiovascular Society, 9 Diabetes Canada, 10 European Atherosclerosis Society, 11 and Heart UK. It also lowered other cardiovascular disease (CVD) risk factors, including the alternate blood lipid targets of non‐high‐density lipoprotein cholesterol by 14% and ApoB (apolipoprotein B) by 15%, and CRP (C‐reactive protein) by 32%. 3 Recently, a systematic review and meta‐analysis of metabolically controlled and ad libitum trials showed that the Portfolio Diet significantly lowered LDL‐C by 17% (27% in the intended combination with an National Cholesterol Education Program Step II diet). 6 Early findings from a metabolically controlled randomized trial showed that the LDL‐C lowering effect of the Portfolio Diet was similar to the control diet taken with 20mg lovastatin (−28.6% versus −30.9%). An extension of the diet includes adding monounsaturated fats (MUFAs such as olive/canola oil or avocado). 1, 2, 3, 4, 5, 6 The underlying diet is low in saturated fat and cholesterol (National Cholesterol Education Program Step II diet 7), with the addition of a “portfolio” of 4 cholesterol‐lowering foods and nutrients: nuts, plant protein (soy and pulses), viscous fiber (oats, barley, psyllium, eggplant, okra, apples, oranges, and berries), and phytosterols (originally provided as enriched margarine). The Dietary Portfolio, or Portfolio Diet, is a plant‐based dietary pattern that was developed in the early 2000s to lower low‐density lipoprotein cholesterol (LDL‐C).
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Given the increased interest in plant‐based foods and diets around the world, and growing concerns related to ethical and environmental implications of diet, the Portfolio Diet warrants attention from healthcare professionals as another therapeutic dietary approach for cardiovascular disease risk reduction. These results remained statistically significant after several sensitivity analyses. After multiple adjustments, adherence to the Portfolio Diet score was associated with lower risk of total CVD (HR, 0.89 95% CI, 0.83–0.94), coronary heart disease (HR, 0.86 95% CI, 0.78–0.95), and heart failure (HR, 0.83 95% CI, 0.71–0.99), comparing the highest to lowest quartile of adherence. Over a mean follow‐up of 15.3 years, 13 365 total CVD, 5640 coronary heart disease, 4440 strokes, 1907 heart failure, and 929 atrial fibrillation events occurred. Secondary outcomes were heart failure and atrial fibrillation. Primary outcomes were total CVD, coronary heart disease, and stroke. We used Cox proportional‐hazard models to estimate adjusted hazard ratios (HRs) and 95% CI of the association of adherence to a Portfolio Diet score with CVD outcomes.
#PORT FOLIO DIET FREE#
We followed 123 330 postmenopausal women initially free of CVD in the Women's Health Initiative from 1993 through 2017. Stroke: Vascular and Interventional Neurology.Journal of the American Heart Association (JAHA).Circ: Cardiovascular Quality & Outcomes.Arteriosclerosis, Thrombosis, and Vascular Biology (ATVB).