Sustainable, planetary healthy dietary patterns are associated with lower 20-year incidence of cardiovascular disease: the ATTICA study (2002–2022)

Background/Objectives: Nutrition epidemiology research scarcely focuses on the relationship between dietary patterns that are beneficial for both planet and human health. This study aimed to examine the association between adherence to a sustainable, planetary-healthy dietary pattern, i.e., the EAT-Lancet Reference Diet (EAT-LD), and 20-year cardiovascular disease (CVD) incidence, in a Mediterranean population. Subjects/Methods: Τhe ATTICA study is a prospective cohort study with a baseline phase in 2002 and 3 consecutive follow-ups (in 2006, 2012, 2022). The EAT-Lancet Index (EAT-LI) and the MedDietScore scales were calculated based on previously published guidelines to assess the adherence to the respective dietary pattern. The current sample consisted of 1,988 Greek adults initially free-of-CVD at baseline. The development of a cardiovascular event was assessed throughout the 20-year period (WHO-ICD-10 classification). Results: The 20-year incidence of CVD was 3600 cases/10,000 individuals (95%Confidence Interval-CI: 3506 to 3695/10,000). Median (interquartile range) values for EAT-LI and MedDietScore were 17 (6.2) out of possible 42 points and 27 (2.9) out of possible 55 points, respectively. Both diet scales were inversely associated with 20-year CVD incidence [Hazard Ratio-HR (95% CI) per 1 point (of possible 42 points) of EAT-LI: 0.83 (0.77–0.90) and per 1 point (of possible 55 points) of MedDietScore: 0.90 (0.84–0.93)]. Conclusion: Our findings highlight that diets that are good for planetary health, are also healthy for humans. Promoting diets that are culturally acceptable, economically viable, easily accessible, planet-friendly, and sustainable should be a key strategy for enhancing both public and planetary health.