BACKGROUND: Healthy dietary patterns are recommended to prevent cardiovascular disease (CVD), yet the relationships among healthy dietary patterns, blood metabolite profile, and incident CVD are not well understood.

OBJECTIVES: This study aimed to assess the associations of healthy dietary patterns and related serum metabolite profiles with incident CVD in United States Hispanic/Latino adults.

METHODS: The study included 13,922 participants aged 18-74 y from the Hispanic Community Health Study/Study of Latinos. Dietary pattern scores, including Healthy Eating Index (HEI)-2020, healthful Plant-based Diet Index (hPDI), and alternate Mediterranean diet score (aMED), were constructed at baseline (2008-2011) based on 2 24-h dietary recalls. The primary outcome was incident CVD, encompassing myocardial infarction, heart failure, and stroke. Dietary-pattern-associated metabolites were identified in a subsample of participants free of diabetes at baseline (n = 4096). Associations of dietary pattern scores, individual metabolites, and metabolite scores with incident CVD were evaluated using multivariable Cox regression.

RESULTS: During a median 9.7-y follow-up period, 260 CVD events occurred among 13,922 participants. After adjusting for demographic, socioeconomic and behavioral factors, higher dietary pattern scores were associated with lower risk of CVD [hazard ratios (HRs) = 0.53 (95% confidence interval: 0.30, 0.92), 0.50 (0.27, 0.91) and 0.62 (0.36, 1.07) for HEI-2020, hPDI, and aMED, respectively, by comparing the highest tertile to the lowest tertile]. A total of 60 metabolites were identified to be associated with all 3 dietary pattern scores, including 45 metabolites positively and 15 metabolites negatively associated with dietary pattern scores. A total metabolite score based on these 60 dietary-pattern-associated metabolites was negatively associated with the risk of CVD after multivariable adjustment [HR = 0.57 (0.35, 0.92) by comparing the highest tertile to the lowest tertile].

CONCLUSIONS: Healthier diet patterns and related serum metabolite profiles are associated with a lower risk of CVD in United States Hispanic/Latino adults.