The Dietary Guidelines for Americans (2015-2020) promoted many healthy dietary patterns for the prevention of cardiovascular disease (CVD). However, the association between adherence to these dietary habits and CVD risk remained unknown among US Hispanics/Latinos. The Hispanic Community Health Study/Study of Latinos comprised 10,766 adult individuals from six Hispanic/Latino origins (Mexican, Puerto Rican, Cuban, Dominican, Central American, and South American) who were free of CVD or cancer at baseline. Food pattern scores were calculated using data from two 24-hour dietary recalls at baseline (2008-11). During an average 6-year follow-up period, the primary outcome was major incident CVD (n=248), which included coronary heart disease and stroke. After adjusting for demographic, socioeconomic, and behavioral factors, as well as sampling weights, relative risks for CVD were calculated using survey Poisson regression.

Mean scores for all three dietary quality indicators differed considerably among six Hispanic/Latino background groups (all P<0.001), with Mexicans scoring the highest (healthier) and Puerto Ricans scoring the lowest. When compared to Hispanics/Latinos born outside the mainland US, Hispanics/Latinos born in the US had considerably worse dietary quality ratings (all P<0.001), particularly in the Mexican, Dominican, and Central American background groups. Dietary disparities between non-US-born and US-born Hispanics/Latinos were mostly driven by the consumption of nutritious plant-based foods (e.g., whole grains, fruits, vegetables, legumes, and nuts). They discovered substantial inverse relationships between the three dietary indicators and CVD risk across tertiles. When comparing highest to lowest tertiles in the overall sample, the relative risk of CVD was 0.54 (95% CI 0.37-0.81; P-trend=0.002) for aMED, 0.64 (95% CI 0.39-1.05; P-trend=0.033) for HEI-2015, and 0.56 (95% CI, 0.35-0.88; P-trend=0.009) for hPDI after multivariable adjustment. The correlations between dietary quality ratings and CVD risk were not varied among Hispanic/Latino origins (all P for interaction≥ 0.24), nor were they differed by US-born status (all P for interaction≥ 0.25).

Adherence to healthy eating habits, as measured by three diet quality indices, differed by Hispanic/Latino background and immigrant generation, with better compliance linked with a decreased risk of CVD in the US Hispanic/Latino population.