The 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. This 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. We analyzed data from 6,646 adults in the Ansan–Ansung cohort of the Korean Genome and Epidemiology Study from baseline (2001–2002) through the 9th follow-up (2019–2020). DASH scores were calculated from 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. Mean DASH scores 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 (Q5 compared with Q1: hazard ratio (HR): 0.60; 95% confidence interval (CI): 0.36, 0.99), with a non-linear trend observed in restricted cubic spline analyses. No significant association was found in male participants. MSMs estimates were consistent with Cox 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). Higher DASH adherence was associated with lower CVD incidence among female participants. Consistent findings across Cox and MSMs analyses provides 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.
Kim et al. (Sun,) studied this question.