Healthy and unhealthy plant-based diets and the risk of cardiovascular diseases: The Rotterdam study and updated meta-analysis

• Published in: Progress in cardiovascular diseases 2024-11, Vol.87, p.8-15
• Main Authors: Wang, Xiang Jun, Voortman, Trudy, de Crom, Tosca O.E., Tilly, Martijn, Kavousi, Maryam, Ikram, M. Kamran, Steur, Marinka
• Format: Article
• Language: English
• Subjects: Cardiovascular health; Coronary heart diseases; Dietary pattern; Plant-based diet index; Plant-based eating; Stroke
• ISSN: 0033-0620
• DOI: 10.1016/j.pcad.2024.10.008

Consumption of more plant-based foods is gaining popularity, but the role of healthy versus unhealthy plant-based diets in cardiovascular disease (CVD) risk remains inconclusive. We investigated associations of plant-based diet indices (PDIs) with incident CVDs in a prospective cohort study and conducted an updated meta-analysis. We included 3507 men and 5345 women of the population-based Rotterdam Study. Multivariable Cox proportional hazard models were used to estimate hazard ratios (HRs) and 95 % confidence intervals (CIs) for CVD, coronary heart disease (CHD) and stroke per SD increment of an overall PDI, healthy PDI (hPDI) and unhealthy PDI (uPDI), among men and women separately. We combined our findings with previously published effect estimates in an updated meta-analysis. We documented 2015 CVD cases (1231 CHD and 952 stroke) during 107,290 person-years follow-up. Among men, the PDI and hPDI were associated with a 7 % (HR 0.93, 95 % CI 0.87–0.99) and 8 % (HR 0.92, 95 % CI 0.86–0.98) lower CVD risk. Among women, there was evidence suggesting a U-shaped association of the PDI with stroke (pnon-linearity