Vegetarian Dietary Patterns and Cardiovascular Disease

doi:10.1016/j.pcad.2018.05.002

Progress in Cardiovascular Diseases

Volume 61, Issue 1, May–June 2018, Pages 54-61

https://doi.org/10.1016/j.pcad.2018.05.002 Get rights and content

Abstract

Cardiovascular (CV) disease (CVD) is the leading global cause of mortality, being responsible for 46% of non-communicable disease deaths. It has been estimated that about 85.6 million Americans are living with some form of CVD, which continues to rise. Healthy lifestyle choices may reduce the risk of myocardial infarction by >80%, with nutrition playing a key role. Vegetarian dietary patterns reduce CVD mortality and the risk of coronary heart disease (CHD) by 40%. Plant-based diets are the only dietary pattern to have shown reversal of CHD. Additionally, evidence suggests benefits of vegetarian dietary patterns in both the prevention and the treatment of heart failure and cerebrovascular disease. Plant-based diets are associated with lower blood pressure, lower blood lipids, and reduced platelet aggregation than non-vegetarian diets and are beneficial in weight management, reduce the risk of developing metabolic syndrome, and type 2 diabetes. They have also been shown an effective treatment method in diabetes management. Well planned vegetarian diets provide benefits in preventing and reversing atherosclerosis and in decreasing CVD risk factors and should be promoted through dietary guidelines and recommendations.

Section snippets

a) CVD mortality

Several prospective studies have assessed cardiovascular mortality in vegetarians. A 2012 meta-analysis by Huang et al. that included seven studies with a total of 124,706 participants, showed significantly lower mortality from coronary disease (CHD) in vegetarians (RR = 0.71; 95% CI 0.56 to 0.87), compared with non-vegetarians.²⁰ A 2014 meta-analysis by Kwok et al. demonstrated an even greater benefit associated with vegetarian diets in Seventh-day Adventist studies, in which the relative risk

a) Blood pressure

Worldwide, nearly 900 million people have high blood pressure (BP), i.e., systolic BP ≥ 140 mmHg.⁴⁸ In the U.S. alone, approximately 75 million Americans, or 33% of the population, have high BP or hypertension (HTN), and another third has pre-HTN, according to statistics from the Centers of Disease Control and Prevention.⁴⁹ Elevations in BP can substantially increase one's risk of death from stroke and CVD,⁵⁰^,⁵¹ while decrease in BP can reduce the risk, as well as risk of death from any cause.⁵²

Potential mechanisms responsible for the benefits of vegetarian dietary patterns in CVD

The CV benefits of vegetarian dietary patterns are the result of both the consistently lower exposure to harmful substances contained in animal products (for example, saturated fat, cholesterol, heme iron, N-glycolylneuraminic acid, persistent organic pollutants, polycyclic aromatic hydrocarbons, heterocyclic amines, and advanced glycation end products) and greater consumption of whole plant foods rich in fiber and phytonutrients. Phytonutrients represent thousands of compounds such as

Diet quality

According to the Academy of Nutrition and Dietetics, “… appropriately planned vegetarian, including vegan, diets are healthful, nutritionally adequate and may provide health benefits for the prevention and treatment of certain diseases.”¹¹ All essential nutrients are available in plants, although in varying amounts depending on the source. Some non-essential nutrients are less available or essentially absent in plant sources, including saturated fat and cholesterol. People who follow vegan

Wellbeing and quality of life (QoL)

Several randomized clinical trials demonstrated that vegetarian dietary patterns significantly improved psychological wellbeing and QoL. More specifically, improvements in depression scores, anxiety, emotional wellbeing, physical wellbeing, general health and general QoL have been observed.¹⁴¹^,¹⁴⁷^,¹⁴⁸ All of these are important for adherence to vegetarian diets both in the short and in the long term.

Conclusions

In conclusion, strong and consistent evidence from multiple clinical trials and observational studies supports beneficial effects of vegetarian dietary patterns for CVD. Well planned vegetarian diets provide benefits in preventing and reversing atherosclerosis and in decreasing CVD risk factors. Limited evidence suggests that the CV benefits seem to be greater with vegan than lacto-ovo-vegetarian diets.¹⁵¹ The use of vegetarian dietary patterns as a means of prevention, reversal and treatment

Acknowledgements

We thank Daya Desai for providing several references for this paper.

Conflict of interest

There is no conflict of interest of any of the listed authors.

Funding

This work was funded by PCRM.

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^☆: Statement of Conflict of Interest: see page 59.

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Vegetarian Dietary Patterns and Cardiovascular Disease☆

Abstract

Section snippets

a) CVD mortality

a) Blood pressure

Potential mechanisms responsible for the benefits of vegetarian dietary patterns in CVD

Diet quality

Wellbeing and quality of life (QoL)

Conclusions

Acknowledgements

Conflict of interest

Funding

Lancet

J Acad Nutr Diet

Lancet

Am J Cardiol

Am J Cardiol

Am J Clin Nutr

Int J Cardiol

Prev Med

Int J Cardiol

Am J Cardiol

J Am Coll Cardiol

Am J Clin Nutr

Circ Heart Fail

Am Heart J

J Electrocardiol

J Stroke Cerebrovasc Dis

Nutrition

J Am Coll Cardiol

Lancet

Am J Clin Nutr

Am J Cardiol

Am J Clin Nutr

Lancet

Am J Clin Nutr

Am J Clin Nutr

Am J Clin Nutr

Nutrition

J Acad Nutr Diet

Int J Cardiol

Global status report on noncommunicable diseases

Projections of global mortality and burden of disease from 2002 to 2030

PLoS Med

Heart disease and stroke statistics-2016 update: a report from the american heart association

Circulation

Third report of the national cholesterol education program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel III) final report

Circulation

Combined effect of low-risk dietary and lifestyle behaviors in primary prevention of myocardial infarction in women

Arch Intern Med

Healthy living is the best revenge: findings from the European prospective investigation into Cancer and nutrition-potsdam study

Arch Intern Med

Healthy lifestyle factors in the primary prevention of coronary heart disease among men: benefits among users and nonusers of lipid-lowering and antihypertensive medications

Circulation

The state of US health, 1990–2010: burden of diseases, injuries, and risk factors

JAMA

Recommended dietary pattern to achieve adherence to the American Heart Association/American College of Cardiology (AHA/ACC) guidelines: a scientific statement from the American Heart Association

Circulation

Intensive lifestyle changes for reversal of coronary heart disease

JAMA

The contribution of changes in diet, exercise, and stress management to changes in coronary risk in women and men in the multisite cardiac lifestyle intervention program

Ann Behav Med

Vegetarian dietary patterns and mortality in adventist health study 2

JAMA Intern Med

Cardiovascular disease mortality and cancer incidence in vegetarians: a meta-analysis and systematic review

Ann Nutr Metab

Global progress in prevention of cardiovascular disease

Cardiovasc Diagn Ther

Vegetarian, vegan diets and multiple health outcomes: a systematic review with meta-analysis of observational studies

Crit Rev Food Sci Nutr

Regression of coronary atherosclerosis through healthy lifestyle in coronary artery disease patients–Mount Abu open heart trial

Indian Heart J

A way to reverse CAD?

J Fam Pract

Eur Heart J

Burden of new hospitalization for heart failure: a population-based investigation from Italy

Eur J Heart Fail

Relation between modifiable lifestyle factors and lifetime risk of heart failure

JAMA

Fruit and vegetable intake and rate of heart failure: a population-based prospective cohort of women