The Food Compass Score demonstrates a stronger association with cardiovascular disease risk over a 20-year follow-up period compared to a 10-year follow-up period, indicating that the protective effect of higher diet quality accumulates over time and is not detectable in shorter follow-up durations.

Eating a diet rich in whole plants, healthy fats, and minimally processed foods over many years steadily lowers harmful oxidative damage and inflammation in blood vessels. This slow, ongoing process prevents the buildup and rupture of fatty plaques in arteries, which eventually reduces the chance of heart attacks and strokes. Shorter periods of healthy eating do not allow enough time for this protective effect to become measurable.