When diets align for cardiovascular & planetary health

The scientific evidence linking dietary patterns to cardiovascular health and other chronic health outcomes is long established, with broad consensus among global cardiovascular experts on the optimum cardioprotective diet^1–3. In parallel, the urgency to adopt more environmentally sustainable food systems has grown^4–6, raising a critical question for both public health and environmental policy: can a single dietary pattern support both human and planetary health?

This dual challenge has prompted increasing interest in the alignment between established health-promoting diets and those designed to minimise environmental burden⁷. A landmark step in this direction came in 2019, when the EAT-Lancet Commission brought together 37 scientists from diverse disciplines to define a global reference diet – the EAT-Lancet Planetary Health Diet (EAT PHD)⁵. Designed to reduce non-communicable diseases and halve the environmental impact of food systems, the EAT PHD is now widely recognised as a benchmark diet for planetary and human health.

Since its publication, several studies have explored the health outcomes associated with adherence to the EAT PHD^4,6,7.

Two recent large European cohort studies have reported findings that reinforce the synergies between environmental sustainability and cardiovascular health^8,9.

Study 1: EAT-Lancet Planetary Health Diet, Mediterranean Diet and Cardiovascular Disease Incidence in a Greek Population

Findings from the ATTICA cohort study examined the impact of adherence to the EAT-Lancet Planetary Health Diet (EAT PHD) and the Mediterranean Diet on the incidence of cardiovascular disease (CVD) over a 20-year follow-up period⁹.

Background

The ATTICA study is a prospective cohort study of Greek adults without CVD or other chronic diseases at baseline, recruited between 2001 and 2002. The study aims to evaluate associations between CVD risk factors and long-term incidence.

Aim

This recent analysis focused on participants’ adherence to the EAT PHD and Mediterranean Diet, and their association with CVD incidence over two decades.

Method

Data from approximately 2,000 participants were included. Dietary adherence was assessed using the EAT-Lancet Index (EAT-LI; score range 0–42) and the Mediterranean Diet Score (MDS; score range 0–55). Higher scores indicated greater adherence.

Results

Over the 20-year follow-up, 3,600 CVD events were recorded. Both higher EAT-LI and MDS scores were significantly associated with reduced CVD incidence.

• Each 1-point increase in EAT-LI was associated with a 17% reduction in CVD risk (HR 0.83; 95% CI: 0.77–0.90)
• Each 1-point increase in MDS was associated with a 10% reduction in CVD risk (HR 0.90; 95% CI: 0.84–0.93)

Study 2: EAT PHD, Mediterranean Diet, All-Cause Mortality and Environmental Footprint in a Spanish Population

Presented on 4 April 2025 at the ESC Preventive Cardiology meeting in Madrid, this study explored the correlation between adherence to the EAT PHD and Mediterranean Diet with all-cause mortality and environmental impact⁸.

Background

Data were drawn from the prospective ENRICA cohort study, which investigates dietary patterns and CVD risk in Spanish adults. A total of 11,488 men and women were recruited between 2008 and 2010, with an average follow-up of 14 years.

Aim

This analysis assessed how adherence to the EAT PHD and Mediterranean Diet related to all-cause mortality, and additionally evaluated the environmental impact of each dietary pattern.

Method

Adherence was measured using the Planetary Health Diet Index (PHD-I; range 0–140) and the MEDAS Mediterranean Diet Score (range 0–14). Higher scores indicated greater adherence. Participants were grouped into tertiles based on adherence scores, and hazard ratios for all-cause mortality were calculated. Environmental impact was assessed by estimating greenhouse gas emissions (GHGe) and land use for each dietary pattern.

Results

Higher adherence to both diets was associated with reduced all-cause mortality:

• Participants in the highest tertile for PHD-I had a 22% lower risk (HR 0.78; 95% CI: 0.66–0.91)
• Those in the highest tertile for MEDAS had a 21% lower risk (HR 0.79; 95% CI: 0.68–0.93)

In terms of environmental footprint, both diets were similar

In summary

Together, these two recent cohort studies further strengthen the evidence base for the convergence of cardioprotective and environmentally sustainable diets. The findings reinforce that the EAT-Lancet Planetary Health Diet and the Mediterranean Diet - both linked to improved cardiovascular outcomes - also support a lower environmental impact. These dietary patterns are not only compatible but aligned, offering a unified strategy for promoting human and planetary health.

References

1. Arnett DK, Khera A, Blumenthal RS. 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: Part 1, Lifestyle and Behavioral Factors. JAMA Cardiology. 2019;4(10):1043-1044. doi:10.1001/jamacardio.2019.2604

2. Visseren FLJ, Mach F, Smulders YM, et al. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice: Developed by the Task Force for cardiovascular disease prevention in clinical practice with representatives of the European Society of Cardiology and 12 medical societies With the special contribution of the European Association of Preventive Cardiology (EAPC). European Heart Journal. 2021;42(34):3227-3337. doi:10.1093/eurheartj/ehab484

3. NICE. NG238: Cardiovascular disease: risk assessment and reduction, including lipid modification. NICE. December 14, 2023. Accessed April 10, 2025. https://www.nice.org.uk/guidance/ng238/chapter/Recommendations

4. Dimbleby H. The National Food Strategy - The Plan. The National Food Strategy; 2022. Accessed August 14, 2023. https://www.nationalfoodstrategy.org/

5. Willett W, Rockström J, Loken B, et al. Food in the Anthropocene: the EAT–Lancet Commission on healthy diets from sustainable food systems: Supplementary Material page 40. The Lancet. 2019;393(10170):447-492. doi:10.1016/S0140-6736(18)31788-4

6. Halevy S, Trewern J. Eating for Net Zero: How Diet Shift Can Enable a Nature Positive Net-Zero Transition in the UK. WWF-UK; 2023:39. https://www.wwf.org.uk/eating-for-net-zero

7. HEART UK. Sustainable Diets. HEART UK - Nutrition Academy. June 2024. Accessed September 8, 2024. https://www.heartuk.org.uk/dietary-patterns/sustainable-diets

8. Aznar de la Riera MDC, Ortolá R, Kales SN, et al. Health and environmental dietary impact: Planetary health diet vs. Mediterranean diet. A nationwide cohort in Spain. Sci Total Environ. 2025;968:178924. doi:10.1016/j.scitotenv.2025.178924

9. Damigou E, Downs SM, Chrysohoou C, et al. Sustainable, planetary healthy dietary patterns are associated with lower 20-year incidence of cardiovascular disease: the ATTICA study (2002–2022). Eur J Clin Nutr. Published online February 25, 2025:1-8. doi:10.1038/s41430-025-01586-1