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Plant-based diets, stroke, and heart outcomes: a prospective study of the REasons for Geographic and Racial
Emily H Belarmino1, Jessica Blair2, Neil A Zakai3
1Department of Nutrition and Food Sciences, University of Vermont, Burlington, VT, United States; Gun Institute for Environment, University of Vermont, Burlington, VT, United States.
Background:
Plant-based diets may protect against adverse cardiovascular outcomes, but the level of protection may differ by dietary composition and individual characteristics. Black and rural Americans-2 groups with high burden of cardiovascular morbidity and mortality-have had limited representation in plant-based diet research.
Objectives:
This prospective cohort study examined associations between plant-based diets and stroke incidence, coronary artery disease (CAD) incidence, and CAD mortality among participants in the REasons for Geographic and Racial Differences in Stroke study.
Methods:
This study included 14,776 adults. Three plant-based diet scores were calculated from food frequency questionnaires: plant-based diet index (PDI), healthy plant-based diet index (hPDI), and unhealthy plant-based diet index (uPDI). Cox proportional hazards models estimated associations of quintiles of each plant-based diet score and cardiovascular outcomes, adjusting for sociodemographic characteristics, health risk factors, and caloric intake.
Results:
Between baseline (2003-2007) and 2019, there were 700 cases of incident stroke, 1047 cases of incident CAD, and 944 CAD deaths. Plant-based diets were not associated with stroke. Comparing the highest to lowest quintile, higher hPDI was associated with lower CAD incidence [hazard ratio (HR): 0.72; 95% confidence interval (CI): 0.58, 0.90; P-trend = 0.03]. An interaction (P = 0.03) between hPDI and sex for CAD mortality revealed an inverse association between hPDI and mortality among females only. PDI was associated with lower CAD-related mortality (HR: 0.73; 95% CI: 0.59, 0.90; P-trend = 0.001), but higher risk of incident CAD (HR: 1.60; 95% CI: 1.09, 2.33; P-trend = 0.009). An interaction (P = 0.006) was found between PDI and urban status for incident CAD, with higher PDI associated with higher CAD among nonrural adults only. The uPDI was not associated with CAD incidence or mortality. Associations did not differ by race.
Conclusions:
In this study, greater adherence to healthy plant-based diets was associated with lower CAD risk, but overall plant-based diets had heterogeneous associations with CAD incidence and mortality. Healthy plant-based diets appear to support heart health.
