A vegan diet may be considered in patients with CAD on guideline-based therapy to lower high-sensitivity C-reactive protein, a risk marker of adverse outcomes, according to findings published in the Journal of the American Heart Association.
For the open-label, masked endpoint EVADE CAD trial, researchers randomly assigned 100 participants with CAD to 8 weeks of a vegan diet or an AHA-recommended diet. All participants received a provision of groceries, tools to measure dietary intake and dietary counseling. Although not powered for clinical endpoints, none had an MI, underwent unplanned coronary revascularization or died during the study period, and no participants had a cerebrovascular event in the vegan diet group. Two participants in the AHA diet group had a probable transient ischemic attack as determined by a clinical neurologist consultant.
Source of protein
“We as interventional cardiologists have a lot of patients that ask us after we’ve opened a blockage, what they can do about cardiovascular health. The mention of diet changes is what patients usually end up asking the most questions about,” Binita Shah, MD, MS, interventional cardiologist and assistant professor of medicine at the NYU Langone Health Center and a Cardiology Today Next Gen Innovator, said during an interview. “With funding and relevant experts on hand, it seemed like a perfect setup for a trial on animal- vs. plant-based protein in patients with significant coronary artery disease. We wanted to keep it relevant to our patient population, and so patients were optimized on their medications and we chose to have the control diet be the American Heart Association-recommended diet since we really wanted to know whether or not it is the source of protein that makes a difference, if any.”
A vegan diet resulted in a 32% lower high-sensitivity CRP (beta = 0.68; 95% CI, 0.49-0.94) when compared with the AHA diet. The findings persisted when adjusted for age, race, baseline waist circumference, diabetes and prior MI (adjusted beta = 0.67; 95% CI, 0.47-0.94).
Though both groups experienced weight loss, the degree of reduction in BMI and waist circumference did not significantly differ between the groups (BMI: adjusted beta = 0.99; 95% CI, 0.97-1; waist circumference: adjusted beta = 1; 95% CI, 0.98-1.01), and there was also no significant difference in the change in glycemic markers between diet groups.
The researchers identified a nonsignificant 13% reduction in LDL with the vegan diet compared with the AHA diet (adjusted beta = 0.87; 95% CI, 0.78-0.97), but found no significant differences in other lipid parameters.
Shah told Cardiology Today the decision to use olive oil as opposed to other heart-healthy oils was a result of the publishing of the PREDIMED trial, which showed participants randomly assigned to nuts and olive oil vs. a control diet did much better in terms of their CV health.
Shah said she believes that the study warrants a larger outcomes trial and might lead to a change in guidelines regarding diets for high-risk patients.
“If a patient has coronary artery disease and has persistently elevated high sensitivity C-reactive protein despite optimal medical therapy, they may want to consider substituting animal-based protein for plant-based protein to lower their inflammatory level,” Shah said. – by Earl Holland
Disclosures: The authors report no relevant financial disclosures.