Vegetarian Nutrition (VN) DPG Public Library

Quek J, Lim G, Lim WH, et al.
Journal: Frontiers in Cardiovascular Medicine
Published: 2021

Key Points

• Aims: The study aimed to assess the association between plant-based diets and cardiovascular disease (CVD) outcomes, considering overall adherence and distinctions between healthful and less healthful plant-based diets.

• Study Design: The meta-analysis included 13 prospective cohort studies involving 410,085 participants aged 38–67 years old, BMI range of 23.0–29.7 kg/m².

• Methodology: Two authors independently reviewed articles. The study used hazard ratios and adjusted for various factors. The inclusion of recently developed plant-based indices provided a more comprehensive assessment.

• Quality assessment: Most included studies had a low risk of bias.

• Greater adherence to a plant-based dietary pattern was associated with a:

  • 8% lower risk of cardiovascular mortality (95%CI, 0.86 to 0.99, p = 0.0193, N = 124,501).

  • 10% lower risk of CVD incidence (95%CI, 0.82 to 0.98, p = 0.0173, N = 323, 854).

• Healthful plant-based diets—emphasizing whole grains, fruits, vegetables, nuts, legumes, tea, and coffee—were associated with 13% decreased CVD incidence (95%CI, 0.80 to 0.95, p = 0.0011, N = 71,301).

• Unhealthful plant-based diets (emphasizing refined grains, starches, and sugars) were associated with 5% increased CVD mortality (95%CI, 1.01 to 1.09, p = 0.0123, N = 18,966).

• Vegetarians had 19% lower CVD incidence (95%CI, 0.72 to 0.91, p = 0.004, N = 16,254). Vegetarians had a similar risk of stroke and CVD mortality compared to meat-eaters.

• Significance: Researchers utilized the PDI, allowing for a more nuanced evaluation of adherence to plant-based diets compared to previous meta-analyses. Unhealthful PDI was associated with a modest increased cardiovascular mortality, while healthful PDI was associated with a significant decrease in CVD incidence.

• Future research is needed in patients with existing CVD and in non-western populations. Additionally, future  studies should stratify by sex and examine the duration of adherence and possible dose-response relationship between intake of healthful plant foods and CVD outcomes.

Conclusion

Adherence to a plant-based diet, especially one emphasizing healthful food choices, is associated with a lower risk of cardiovascular mortality and CVD incidence. However, unhealthful plant-based diets may increase cardiovascular mortality. The study provides valuable insights into the nuanced effects of different plant-based dietary patterns on cardiovascular health.

Editor's Note: Registered dietitian nutritionists (RDNs) working with patients at risk for CVD should emphasize the favorable role of healthful plant-based foods in reducing CVD incidence and mortality.