AUTHOR=Quek Jingxuan , Lim Grace , Lim Wen Hui , Ng Cheng Han , So Wei Zheng , Toh Jonathan , Pan Xin Hui , Chin Yip Han , Muthiah Mark D. , Chan Siew Pang , Foo Roger S. Y. , Yip James , Neelakantan Nithya , Chong Mary F. F. , Loh Poay Huan , Chew Nicholas W. S. 

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

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=8

YEAR=2021

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2021.756810

DOI=10.3389/fcvm.2021.756810

ISSN=2297-055X

ABSTRACT=<p><bold>Background:</bold> 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.</p><p><bold>Methods and Findings:</bold> 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 <italic>p</italic> = 0.0193, <italic>I</italic><sup>2</sup> = 88.5%, <italic>N</italic> = 124,501) and a lower risk of CVD incidence (pooled HR: 0.90, 95% CI: 0.82–0.98, <italic>p</italic> = 0.0173, <italic>I</italic><sup>2</sup> = 87.2%, <italic>N</italic> = 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, <italic>p</italic> = 0.0123, <italic>I</italic><sup>2</sup> = 0.00%, <italic>N</italic> = 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, <italic>p</italic> = 0.0011, <italic>I</italic><sup>2</sup> = 57.5%, <italic>N</italic> = 71,301), but not mortality. Vegetarians also had significantly lower CVD incidence (HR: 0.81, 95% CI: 0.72–0.91, <italic>p</italic> = 0.0004, <italic>I</italic><sup>2</sup> = 22.2%, <italic>N</italic> = 16,254), but similar CVD mortality or stroke risk when compared to the meat-eaters.</p><p><bold>Conclusion:</bold> 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.</p>