In the JournalsPerspective

Healthy plant-based diet lowers risk for CVD mortality, morbidity

Casey M. Rebholz

Eating more plant-based foods and less animal products lowered the risk for CV morbidity and mortality in a general population of middle-aged adults.

According to a study published in the Journal of the American Heart Association, adults without CVD at baseline who adhered to a plant-based diet had a lower risk for incident CVD, CVD mortality and all-cause mortality during a median follow-up of 25 years.

Cardiology Today corresponded with Casey M. Rebholz, PhD, assistant professor epidemiology at the Bloomberg School of Public Health at Johns Hopkins University, about the new data and implications.

“Cardiologists may already be discussing ways to achieve a healthy diet, by increasing the consumption of fruits, vegetables, and whole grains, and by limiting the consumption of red and processed meat,” Rebholz said. “An overall plant-based diet or provegetarian diet, which are higher in plant foods and lower in animal foods, could be recommended by cardiologists to their patients in order to achieve their dietary goals and to prevent CV morbidity and mortality.”

Eating more plant-based foods and less animal products lowered the risk for CV morbidity and mortality in a general population of middle-aged adults.
Source: Adobe Stock

Researchers used data from the Atherosclerosis Risk in Communities study on 12,168 middle-aged adults who were followed from 1987 to 2016.

Participants were classified based on one of four diet indexes; plant-based diet index, provegetarian diet index, healthy plant-based diet index and less-healthy plant-based diet index. In each category, individuals were given higher or lower scores based on the intake of the specified quality of plant based and animal foods. For example, a healthful plant-based diet was characterized by consumption of whole grains, vegetables and plant proteins, whereas an unhealthful plant-based diet had higher consumption of plant sources of food with refined carbohydrates and sugar.

Results from Cox proportional hazards models, and after adjustment for all cofounders, researchers found that greater adherence to a healthy plant-based diet index was associated with a 19% lower risk for CVD and an 11% lower risk for all-cause mortality, but no improvement in incident CVD (P < .05 for trend).

Researchers also found differences between the highest vs. the lowest quintiles of adherence to an overall plant-based diet index or provegetarian diet, including:

  • a 16% lower risk for CVD;
  • a 31% to 32% lower risk for CVD mortality; and
  • an 18% to 25% lower risk for all-cause mortality (P < .05 for trend for all).

Adherence to the less-healthy plant-based diet index was not associated with incident CVD, CVD mortality or all-cause mortality in this population.

“Progressively increasing the consumption of plant foods by reducing the consumption of foods derived from animals may be beneficial for CV health,” Rebholz said.

Rebholz and colleagues stated that these findings may be generalizable to U.S. adults, including black and white men and women.

“Our findings were consistent with our expectations,” Rebholz said. “Our study adds to a growing body of literature demonstrating that eating a plant-based or vegetarian diet can be heart healthy in terms of reducing the risk of CVD, CV mortality and all-cause mortality.” – by Scott Buzby

For more information:

Casey M. Rebholz, PhD , can be reached at 2024 E. Monument St., Room 2-519, Baltimore, MD 21287; email: crebhol1@jhu.edu.

Disclosures: The authors report no relevant financial disclosures.

Casey M. Rebholz

Eating more plant-based foods and less animal products lowered the risk for CV morbidity and mortality in a general population of middle-aged adults.

According to a study published in the Journal of the American Heart Association, adults without CVD at baseline who adhered to a plant-based diet had a lower risk for incident CVD, CVD mortality and all-cause mortality during a median follow-up of 25 years.

Cardiology Today corresponded with Casey M. Rebholz, PhD, assistant professor epidemiology at the Bloomberg School of Public Health at Johns Hopkins University, about the new data and implications.

“Cardiologists may already be discussing ways to achieve a healthy diet, by increasing the consumption of fruits, vegetables, and whole grains, and by limiting the consumption of red and processed meat,” Rebholz said. “An overall plant-based diet or provegetarian diet, which are higher in plant foods and lower in animal foods, could be recommended by cardiologists to their patients in order to achieve their dietary goals and to prevent CV morbidity and mortality.”

Eating more plant-based foods and less animal products lowered the risk for CV morbidity and mortality in a general population of middle-aged adults.
Source: Adobe Stock

Researchers used data from the Atherosclerosis Risk in Communities study on 12,168 middle-aged adults who were followed from 1987 to 2016.

Participants were classified based on one of four diet indexes; plant-based diet index, provegetarian diet index, healthy plant-based diet index and less-healthy plant-based diet index. In each category, individuals were given higher or lower scores based on the intake of the specified quality of plant based and animal foods. For example, a healthful plant-based diet was characterized by consumption of whole grains, vegetables and plant proteins, whereas an unhealthful plant-based diet had higher consumption of plant sources of food with refined carbohydrates and sugar.

Results from Cox proportional hazards models, and after adjustment for all cofounders, researchers found that greater adherence to a healthy plant-based diet index was associated with a 19% lower risk for CVD and an 11% lower risk for all-cause mortality, but no improvement in incident CVD (P < .05 for trend).

Researchers also found differences between the highest vs. the lowest quintiles of adherence to an overall plant-based diet index or provegetarian diet, including:

  • a 16% lower risk for CVD;
  • a 31% to 32% lower risk for CVD mortality; and
  • an 18% to 25% lower risk for all-cause mortality (P < .05 for trend for all).

Adherence to the less-healthy plant-based diet index was not associated with incident CVD, CVD mortality or all-cause mortality in this population.

“Progressively increasing the consumption of plant foods by reducing the consumption of foods derived from animals may be beneficial for CV health,” Rebholz said.

Rebholz and colleagues stated that these findings may be generalizable to U.S. adults, including black and white men and women.

“Our findings were consistent with our expectations,” Rebholz said. “Our study adds to a growing body of literature demonstrating that eating a plant-based or vegetarian diet can be heart healthy in terms of reducing the risk of CVD, CV mortality and all-cause mortality.” – by Scott Buzby

For more information:

Casey M. Rebholz, PhD , can be reached at 2024 E. Monument St., Room 2-519, Baltimore, MD 21287; email: crebhol1@jhu.edu.

Disclosures: The authors report no relevant financial disclosures.

    Perspective
    Kim Allan Williams Sr.

    Kim Allan Williams Sr.

    This is a powerful message on cardiovascular health, aligning with a vast amount of prospective observational evidence that more plants and less animals consumed results in a longer life with less CV risk and lower disease frequency.

    While we would all prefer large, long-term, prospective, randomized trials with hard outcomes, we can draw stronger conclusions about moving more toward plant-based diets and away from the typical high cholesterol, saturated fat, refined grains and sodium that comprise the American diet.

    This study did not test a completely plant-based diet and therefore cannot easily discern the dose relationship between animal product consumption and adverse events.  The best quintile still had substantial animal products.

    The 2019 ACC/AHA Guideline on the Primary Prevention of CVD, published in March, has a nutrition section. These data support those guidelines and, if adopted, could curb the epidemic of CVD in this nation, prevent the Medicare system’s impending bankruptcy, and improve longevity and productivity. One could make the case that when we eat unhealthy food, knowing the relationship between nutrition, health and disease, perhaps we should pause and question either our information base or our patriotism.

    • Kim Allan Williams Sr., MD, MACC, FAHA, MASNC, FESC
    • Cardiology Today Editorial Board Member
      Rush University Medical Center, Chicago
      Past President, American College of Cardiology

    Disclosures: Williams reports no relevant financial disclosures.