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Aims: To investigate the association between dietary patterns at Ages 40, 50, and 60 and subclinical carotid atherosclerosis at Age 60.

Methods and results: Participants who were 60 years of age at the Swedish VIPVIZA (VisualiZation of asymptomatic Atherosclerotic disease) trial baseline (2013-16) with retrospective VIP (Västerbotten Intervention Programme) dietary data at Ages 40, 50, and 60 (n = 1034) were included. Dietary patterns were assessed using the Mediterranean diet score (MDS) and healthy diet score, while carotid ultrasound was used to measure carotid artery intima-media thickness (CIMT) and carotid plaque (CP). Multivariable regressions and mediation analysis investigated associations, sex differences and potential mediating factors. High [odds ratio (OR): 0.72, 95% confidence interval (CI): 0.52-0.98] or midrange (OR: 0.74, 95% CI: 0.55-0.99) cumulative MDS for Ages 40, 50, and 60, as compared with low, was associated with lower CP presence at Age 60. Initial sex-stratified analysis yielded similar, though non-significant, point estimates. Further analysis revealed that the relationship between plaque and MDS seem driven more by women (OR: 0.41, 95% CI: 0.237-0.703) while a significant association between CIMT and MDS was only present in men (P < 0.05). Healthy diet score during midlife did not show any significant associations with CP or CIMT at Age 60.

Conclusion: Findings underscore associations of midlife Mediterranean-style diet and lower presence of subclinical carotid atherosclerosis at Age 60 and confirm the significance of dietary interventions as potential means for cardiovascular disease prevention. The study enhances understanding of long-term dietary patterns and their link to subclinical atherosclerosis, supporting future interventions and further research.Keywords: Carotid intima media thickness; Carotid plaque; Dietary patterns; Healthy diet score; Mediterranean diet score; Subclinical atherosclerosis.