Plant-based diets and cardiovascular health

Abstract

Plant-based diets, defined in terms of low frequency of animal food consumption, have been increasingly recommended for their health benefits. Numerous studies have found plant-based diets, especially when rich in high quality plant foods such as whole grains, fruits, vegetables, and nuts, to be associated with lower risk of cardiovascular outcomes and intermediate risk factors. This review summarizes the current evidence base examining the associations of plant-based diets with cardiovascular endpoints, and discusses the potential biological mechanisms underlying their health effects, practical recommendations and applications of this research, and directions for future research. Healthful plant-based diets should be recommended as an environmentally sustainable dietary option for improved cardiovascular health.

Keywords: Vegetarian diet; cardiovascular disease; nutritional epidemiology; plant foods; plant-based diets.

Figure 1

Summary effect estimates (95% CI) of pooled and meta-analyses of vegetarian diets in relation to CHD or stroke mortality^– CHD, Coronary Heart Disease; CI, Confidence Interval; RR, Relative Risk

Figure 2

Dose-response relationship of plant-based diet indices with CHD incidence CHD, Coronary Heart Disease; HR, Hazard Ratio; PDI, Overall Plant-based Diet Index; hPDI, Healthful Plant-based Diet Index; uPDI, Unhealthful Plant-based Diet Index For uPDI, p for test of curvature = 0.01 and p for nonlinear association <0.001. The p values for test of curvature for PDI = 0.25, and for hPDI = 0.82. The p values for linearity = 0.001 for PDI, and <0.001 for hPDI. Reprinted from J Am Coll Cardiol, 70, Satija et al., Healthful and Unhealthful Plant-Based Diets and the Risk of Coronary Heart Disease in U.S. Adults, 411–422, Copyright (2017), with permission from Elsevier

Figure 3

Potential mechanisms underlying the cardiovascular effects of healthful plant-based diets