Dietary plant-to-animal protein ratio and risk of cardiovascular disease in 3 prospective cohorts

Affiliations

¹ Department of Nutrition and Food Studies, New York University, New York, NY, United States; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States; Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON, Canada. Electronic address: a.glenn@nyu.edu.
² Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States.
³ Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States; Department of Nutrition, Faculty of Medicine, University of Montreal, Montreal, QC, Canada; Montreal Heart Institute, Montreal, QC, Canada; Institut de Valorisation des Données (IVADO), Montreal, QC, Canada.
⁴ Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States; Division of Preventive Medicine Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States.
⁵ Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States.
⁶ Department of Medicine, Beth Israel Deaconess Medical Centre, Harvard Medical School, Boston, MA, United States.
⁷ Division of Women's Health, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States.
⁸ Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada; Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto, ON, Canada; Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
⁹ Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States. Electronic address: fhu@hsph.harvard.edu.

PMID: 39631999
PMCID: PMC12121410 (available on 2025-12-02)
DOI: 10.1016/j.ajcnut.2024.09.006

Dietary plant-to-animal protein ratio and risk of cardiovascular disease in 3 prospective cohorts

Andrea J Glenn et al. Am J Clin Nutr. 2024 Dec.

. 2024 Dec;120(6):1373-1386.

doi: 10.1016/j.ajcnut.2024.09.006.

Authors

Affiliations

¹ Department of Nutrition and Food Studies, New York University, New York, NY, United States; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States; Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON, Canada. Electronic address: a.glenn@nyu.edu.
² Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States.
³ Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States; Department of Nutrition, Faculty of Medicine, University of Montreal, Montreal, QC, Canada; Montreal Heart Institute, Montreal, QC, Canada; Institut de Valorisation des Données (IVADO), Montreal, QC, Canada.
⁴ Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States; Division of Preventive Medicine Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States.
⁵ Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States.
⁶ Department of Medicine, Beth Israel Deaconess Medical Centre, Harvard Medical School, Boston, MA, United States.
⁷ Division of Women's Health, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States.
⁸ Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada; Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto, ON, Canada; Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
⁹ Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States. Electronic address: fhu@hsph.harvard.edu.

PMID: 39631999
PMCID: PMC12121410 (available on 2025-12-02)
DOI: 10.1016/j.ajcnut.2024.09.006

Abstract

Background: Dietary guidelines recommend substituting animal protein with plant protein, however, the ideal ratio of plant-to-animal protein (P:A) remains unknown.

Objectives: We aimed to evaluate associations between the P:A ratio and incident cardiovascular disease (CVD), coronary artery disease (CAD), and stroke in 3 cohorts.

Methods: Multivariable-adjusted Cox proportional hazard models were used to estimate hazard ratios (HRs) for CVD outcomes among 70,918 females in the Nurses' Health Study (NHS) (1984-2016), 89,205 females in the NHSII (1991-2017) and 42,740 males from the Health Professionals Follow-up Study (1986-2016). The P:A ratio was based on percent energy from plant and animal protein and assessed using food frequency questionnaires every 4 y.

Results: During 30 y of follow-up, 16,118 incident CVD cases occurred. In the pooled multivariable-adjusted models, participants had a lower risk of total CVD [HR: 0.81; 95% confidence interval (CI): 0.76, 0.87; P trend < 0.001], CAD (HR: 0.73; 95% CI: 0.67, 0.79; P trend < 0.001), but not stroke (HR: 0.98; 95% CI: 0.88, 1.09; P trend = 0.71), when comparing highest to lowest deciles of the P:A ratio (ratio: ∼0.76 compared with ∼0.24). Dose-response analyses showed evidence of linear and nonlinear relationships for CVD and CAD, with more marked risk reductions early in the dose-response curve. Lower risk of CVD (HR: 0.72; 95% CI: 0.64, 0.82) and CAD (HR: 0.64; 95% CI: 0.55, 0.75) were also observed with higher ratios and protein density (20.8% energy) combined. Substitution analyses indicated that replacing red and processed meat with several plant protein sources showed the greatest cardiovascular benefit.

Conclusions: In cohort studies of United States adults, a higher plant-to-animal protein ratio is associated with lower risks of CVD and CAD, but not stroke. Furthermore, a higher ratio combined with higher protein density showed the most cardiovascular benefit.

Keywords: animal protein; cardiovascular disease; plant protein; prospective cohort study; protein ratio.

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References

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Dietary plant-to-animal protein ratio and risk of cardiovascular disease in 3 prospective cohorts

Affiliations

Dietary plant-to-animal protein ratio and risk of cardiovascular disease in 3 prospective cohorts

Authors

Affiliations

Abstract

References

MeSH terms

Substances

Grants and funding

LinkOut - more resources

Full Text Sources

Miscellaneous