Fig. 2

Cumulative LDL-C exposure, plaque burden and onset of cardiovascular risk by age according to absolute adherence to the Portfolio Diet. Absolute adherence was related to unadjusted marginal mean LDL-C levels in each PDS tertile determined in our main analysis. LDL-C at other levels of adherence was estimated linearly. The solid black lines represents tertiles 1, 2 and 3 relating to LDL-C levels of 2.34, 2.29 and 2.24mmol/L throughout life, respectively. The solid blue line represents 50% absolute adherence to Portfolio Diet recommendations relating to an estimated LDL-C level of 2.13mmol/L throughout life. The solid orange line represents 100% absolute adherence to Portfolio Diet recommendation relating to an estimated LDL-C level of 1.89mmol/L throughout life. Cumulative LDL-C exposure was calculated by multiplying LDL-C levels by age. The black dots represent the cumulative LDL-C level at 23 years of age, equal to the mean age of the TNH Study cohort. The red dots represent the average age where cumulative LDL-C reaches 125mmol-years marking the threshold for the onset of exponential myocardial infarction risk increase. Age at which risk of myocardial infarction begins to rise is 55 years for 6% adherence (T1), 61 years for 50% adherence and 68 years for 100% adherence. Modeled using methods from Ference BA et al. J Am Coll Cardiol 2018; 72(10):1141-56 [38]. T1 (low), T2 (mid), and T3 (highest) tertiles of adherence to the Portfolio dietary pattern measured using the Portfolio Diet Score (PDS). c-PDS, clinical-Portfolio Diet Score; LDL-C, low-density lipoprotein cholesterol; MI, myocardial infarction; T, tertile