ArticleThe American journal of clinical nutrition2026
Adherence to the Dietary Approaches to Stop Hypertension score and cardiovascular disease risk in Korean adults: a prospective cohort study using marginal structural models.
Article in The American journal of clinical nutrition, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundThe prevalence and mortality of cardiovascular disease (CVD) have increased in Korea. Although the Dietary Approaches to Stop Hypertension (DASH) diet is widely recognized for its association with CVD risk, evidence in Korean populations remains limited.
objectivesThis study examined the association between DASH adherence and CVD incidence among Korean adults using statistical approaches that account for time-varying exposure and selection bias.
methodsWe analyzed data from 6646 adults in the Ansan-Ansung cohort of the Korean genome and epidemiology study from baseline (2001-2002) through the ninth follow-up (2019-2020). DASH scores were calculated from the food frequency questionnaire. CVD outcomes included myocardial infarction, stroke, coronary artery disease, and congestive heart failure. Associations were evaluated using Cox proportional hazards models and marginal structural models (MSMs) to address time-varying confounding and informative censoring.
resultsMean DASH scores (mean ± SD) were lower in male participants (22.5 ± 4.2) than in female participants (25.4 ± 3.7). In multivariable-adjusted models, higher DASH adherence was associated with lower CVD incidence among female participants [quintile 5 compared with quintile 1: hazard ratio (HR): 0.60; 95% confidence interval (CI): 0.36, 0.99], with a nonlinear trend observed in restricted cubic spline analyses. No significant association was found in male participants. MSM's estimates were consistent with Cox's results (HR: 0.53; 95% CI: 0.28, 0.99). Among individual DASH components, higher sodium intake was associated with increased CVD risk in female participants (HR: 1.30; 95% CI: 1.03, 1.65).
conclusionsHigher adherence to the DASH diet was associated with lower CVD incidence among female participants. Consistent findings across Cox and MSMs analyses provide supportive evidence under causal assumptions. These findings suggest that the DASH dietary pattern may inform population-level dietary strategies for CVD prevention in Korean adults.
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