(P05-38-26) Association Between the Planetary Health Diet Index and Risk of Cardiovascular Diseases in Postmenopausal Women: Findings From the Women’s Health Initiative

Saturday, July 25, 2026

11:30 AM - 12:30 PM ET

Location: Poster Board G-89

Presenting Author(s)

DS

Donya Shahamati, MS (she/her/hers)

PhD student
University of California, Irvine
Irvine, California, United States

Co-Author(s)

Yujue Wang, MS

PhD student
University of California, Irvine
Irvine, California, United States
Matthew J. Landry, PhD, RDN, DipACLM, FAND, FAHA (he/him/his)

Assistant Professor
University of California, Irvine
Irvine, California, United States
Simin Liu, MD, ScD

Chair and Distinguished Professor of the Department of Epidemiology & Biostatistics
University of California, Irvine
Irvine, California, United States
AO

Andrew Odegaard, PhD, MPH

University of California, Irvine
Irvine, California, United States
BY

Bo Yang

University of California, Irvine; and the UCI Center for Global Cardiometabolic Health & Nutrition (CGCHN), United States

Disclosure(s):

Donya Shahamati, MS: No relevant financial relationship(s) with ineligible companies to disclose.

Yujue Wang, MS: No relevant financial relationship(s) with ineligible companies to disclose.

Matthew J. Landry, PhD, RDN, DipACLM, FAND, FAHA: No relevant financial relationship(s) with ineligible companies to disclose.

Objectives: To evaluate the association between adherence to the Planetary Health Diet Index (PHDI), a plant-forward dietary pattern integrating diet quality and sustainability, and incident cardiovascular diseases (CVDs) among postmenopausal women.

Methods: Of the 66,892 postmenopausal women free of CVDs at baseline (1994-1998) in the WHI Observational Study (WHI-OS), we assessed dietary intake using a validated semi-quantitative food frequency questionnaire, calculated PHDI scores (range 0–140) based on EAT-Lancet dietary principles. PHDI was examined in quintiles and per 10-point increments, with moderate adherence defined as intermediate (second and third) quintiles. Incident outcomes, adjudicated through February 2025 included total CVD, coronary heart disease (CHD), and stroke, and heart failure as a secondary outcome. Cox proportional hazards models estimated hazard ratios (HRs) and 95% confidence intervals (CIs), adjusting for sociodemographic characteristics, lifestyle behaviors (smoking status, alcohol intake, physical activity), energy intake, and body mass index.

Results: Among 66,892 women (mean [SD] age, 63.2 [7.3] years) PHDI scores ranged from 35 to 123 (mean ± SD: 75.5 ± 10.3). Over a median follow-up of 19.6 years (IQR: 8.9–26.8), 5,033 incident CVD events occurred. In fully adjusted models, participants in the highest PHDI quintile had decreased risk of CVD (HR 0.72; 95% CI 0.64–0.81) and CHD (HR 0.66; 0.56–0.77) compared to lowest, with lower stroke risk (HR 0.78; 0.66–0.93) and heart failure (HR 0.69; 0.54–0.89). No significant association was observed for hemorrhagic stroke, and p-for-trend values were significant for other outcomes. Risk reductions occurred at moderate adherence, and each 10-point increase in PHDI score was associated with lower risk of major CVD outcomes, with hazard ratios corresponding to ~8–15% risk reduction per outcome.

Conclusions: Among postmenopausal women, higher adherence to the Planetary Health Diet was prospectively associated with lower risk of multiple cardiovascular outcomes, with meaningful risk differences even at moderate levels of adherence.

Funding Sources: The WHI was funded by the National Heart, Lung, and Blood Institute, National Institutes of Health, U.S. Department of Health and Human Services. Partially Supported by the Center for Global Cardiometabolic Health and Nutrition (CGCHN).