Plant-Based Diets Are Associated With a Lower Risk of Incident Cardiovascular Disease, Cardiovascular Disease Mortality, and All-Cause Mortality in a General Population of Middle-Aged Adults

Abstract

Background Previous studies have documented the cardiometabolic health benefits of plant-based diets; however, these studies were conducted in selected study populations that had narrow generalizability. Methods and Results We used data from a community-based cohort of middle-aged adults (n=12 168) in the ARIC (Atherosclerosis Risk in Communities) study who were followed up from 1987 through 2016. Participants' diet was classified using 4 diet indexes. In the overall plant-based diet index and provegetarian diet index, higher intakes of all or selected plant foods received higher scores; in the healthy plant-based diet index, higher intakes of only the healthy plant foods received higher scores; in the less healthy plant-based diet index, higher intakes of only the less healthy plant foods received higher scores. In all indexes, higher intakes of animal foods received lower scores. Results from Cox proportional hazards models showed that participants in the highest versus lowest quintile for adherence to overall plant-based diet index or provegetarian diet had a 16%, 31% to 32%, and 18% to 25% lower risk of cardiovascular disease, cardiovascular disease mortality, and all-cause mortality, respectively, after adjusting for important confounders (all P<0.05 for trend). Higher adherence to a healthy plant-based diet index was associated with a 19% and 11% lower risk of cardiovascular disease mortality and all-cause mortality, respectively, but not incident cardiovascular disease (P<0.05 for trend). No associations were observed between the less healthy plant-based diet index and the outcomes. Conclusions Diets higher in plant foods and lower in animal foods were associated with a lower risk of cardiovascular morbidity and mortality in a general population.

Keywords: cardiovascular disease; diet; morbidity/mortality; vegetation.

Figure 1

Adjusted hazard ratios and 95% CIs for incident cardiovascular disease, according to the continuous overall plant‐based diet index (PDI). The histogram shows the distribution of scores for the PDI in gray. The solid lines represent the adjusted hazard ratios for incident cardiovascular disease, modeled using 2 linear spline terms with 1 knot at the 12.5th percentile of PDI (score, 44), which was used as the reference point. The dashed lines represent the 95% CIs. Hazard ratios were adjusted for age, sex, race‐center, total energy intake, education, smoking status, physical activity, alcohol consumption, margarine consumption, baseline total cholesterol, lipid medication use, baseline kidney function, hypertension, diabetes mellitus, and baseline body mass index.

Figure 2

Adjusted hazard ratios and 95% CIs for incident cardiovascular disease, according to the continuous provegetarian diet score. The histogram shows the distribution of scores for the provegetarian diet index in gray. The solid lines represent the adjusted hazard ratios for incident cardiovascular disease, modeled using 2 linear spline terms with 1 knot at the 12.5th percentile of the provegetarian diet index (score, 27), which was used as the reference point. The dashed lines represent the 95% CIs. The hazard ratios were adjusted for age, sex, race‐center, total energy intake, education, smoking status, physical activity, alcohol consumption, margarine consumption, baseline total cholesterol, lipid medication use, baseline kidney function, hypertension, diabetes mellitus, and baseline body mass index.