The Association of Plant-Based Diet With Cardiovascular Disease and Mortality: A Meta-Analysis and Systematic Review of Prospect Cohort Studies

Abstract

Background: The association between plant-based diets and cardiovascular disease (CVD) remains poorly characterized. Given that diet represents an important and a modifiable risk factor, this study aimed to assess (1) the relationships between the impact of adherence to plant-based diets on cardiovascular mortality, incident CVD, and stroke; (2) if associations differed by adherence to healthful and less healthful plant-based diets.Methods and Findings: MEDLINE and EMBASE databases were searched up to May 2021. Studies assessing CVD outcomes with relation to plant-based dietary patterns or according to plant-based dietary indices (PDI) were included. A meta-analysis of hazard ratios (HR) was conducted using DerSimonian and Laird random effects model. Thirteen studies involving 410,085 participants were included. Greater adherence to an overall plant-based dietary pattern was significantly associated with a lower risk of cardiovascular mortality (pooled HR: 0.92, 95% CI: 0.86–0.99 p = 0.0193, I2 = 88.5%, N = 124,501) and a lower risk of CVD incidence (pooled HR: 0.90, 95% CI: 0.82–0.98, p = 0.0173, I2 = 87.2%, N = 323,854). Among the studies that used PDI, unhealthful plant-based diets were associated with increased risk of cardiovascular mortality (pooled HR: 1.05, 95% CI: 1.01–1.09, p = 0.0123, I2 = 0.00%, N = 18,966), but not CVD incidence. Conversely, healthful plant-based diets were associated with decreased CVD incidence (pooled HR: 0.87, 95% CI: 0.80–0.95, p = 0.0011, I2 = 57.5%, N = 71,301), but not mortality. Vegetarians also had significantly lower CVD incidence (HR: 0.81, 95% CI: 0.72–0.91, p = 0.0004, I2 = 22.2%, N = 16,254), but similar CVD mortality or stroke risk when compared to the meat-eaters.Conclusion: To date, this comprehensive study examines the effects of a plant-based diet on major clinical endpoints using more holistic PDIs. These findings highlight the favorable role of healthful plant-based foods in reducing cardiovascular mortality and CVD.

Plant-based diet for obesity treatment

“…A recent systematic review by Remde et al ( 46 ), demonstrated that PBD, in general, demonstrated improved weight control and cardiometabolic outcomes. Healthy plant-based foods play a beneficial role in lowering cardiovascular mortality and CVD according to the findings of a meta-analysis and systematic review of prospect cohort studies ( 53 ). Interestingly, another study reported that, PBD (which included Mediterranean, vegetarian, and vegan diets) improved TMAO levels, whereas animal-based diets appear to have the contrary effect ( 54 ).…”

Dietary Therapy in Prevention of Cardiovascular Disease (CVD)—Tradition or Modernity? A Review of the Latest Approaches to Nutrition in CVD

“…There are several types of vegetarian diets, but all of them are characterized by the reduction or exclusion of animal meat consumption [67]. Following a balanced plantbased diet has several benefits [68]. It has been observed that the population of countries whose usual dietary model excludes the consumption of meat is less likely to develop cardiovascular diseases [67].…”

“…It has been observed that the population of countries whose usual dietary model excludes the consumption of meat is less likely to develop cardiovascular diseases [67]. Moreover, a plant-based diet significantly reduces the risk of death from cardiovascular causes [68]. Plant-based diets, unlike diets based on animal meat consumption, provide significant amounts of cardioprotective fiber, beta-glucans, and plant phytosterols that limit the absorption of lipids from the gastrointestinal tract.…”

“…Additionally, vegetarians tend to have lower BMI values compared to non-vegetarians [70]. The American Dietetic Association recommends a varied plant-based diet for those wishing to improve their health [68].…”

Dietary Intake of Manganese in the Japanese Diet and its Association with Cardiometabolic and Cardiovascular Diseases

“…However, in this study, it was green tea beverages, rice, and oolong tea beverages (84%, 7%, and 4%, respectively). Plant-based foods, a major dietary source of manganese, have already been reported to be inversely associated with cardiovascular disease 10) . Therefore, it remains possible that the results of this study are a proxy for plant-food intake rather than manganese intake.…”