ArticleThe American journal of clinical nutrition2026
Cardiovascular disease risk under low-fat, Mediterranean, and American Heart Association diets: a target trial emulation in United States adults.
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.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
0 citing papers in PubMed.
No citing paper in PubMed yet.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
9 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe Mediterranean diet reduces cardiovascular disease (CVD) risk in European populations, but its long-term effectiveness in United States adults, particularly relative to the American Heart Association (AHA)-2020 dietary goals, remains uncertain.
objectivesWe compared 20-y CVD risk in United States adults under sustained adherence to a low-fat diet, a Mediterranean diet, and the food-based AHA-2020 dietary goals.
methodsWe emulated a target trial using data from the Nurses' Health Study and Health Professionals Follow-up Study among 12,197 United States adults aged 55 to 80 y with diabetes or ≥3 major CVD risk factor. Diet was assessed every 4 y via validated food frequency questionnaires. The primary outcome was CVD, defined as nonfatal myocardial infarction, coronary revascularization, stroke, and CVD death, confirmed by medical records. We applied the parametric g-formula to estimate 20-y CVD risk under each dietary strategy.
resultsOver 20 y, 3469 CVD cases occurred (1451 men and 2018 women). Pooled absolute risks of CVD were 35.9% (95% CI: 33.1%, 38.5%) under the low-fat diet, 28.2% (95% CI: 25.8%, 31.4%) under the Mediterranean diet, and 31.2% (95% CI: 29.1%, 33.4%) under the AHA-2020 dietary goals. Compared with the low-fat diet, estimated risk ratios were 0.79 (95% CI: 0.70, 0.91) for the Mediterranean diet and 0.87 (95% CI: 0.79, 0.96) for the AHA-2020 dietary goals. In a general population not selected for age, diabetes, or CVD risk factors, the corresponding risk ratios were 0.90 (95% CI: 0.84, 0.95) and 0.94 (95% CI: 0.90, 0.99), respectively.
conclusionsSustained adherence to the Mediterranean diet and the AHA-2020 dietary goals is estimated to have a lower 20-y risk of CVD than a low-fat diet in United States adults.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.