Vegetarians, Fish, Poultry, Meat-Eaters: Who Has Higher CVD Risk?

Quick Takes

  • Compared with meat-eaters, fish eaters had a lower risk of overall CVD, ischemic heart disease, MI, stroke, and HF after adjustment for confounders.
  • Those who ate poultry as well as fish did not have a lower risk compared to meat-eaters. Vegetarians showed only a lower risk of incident total CVD.
  • Overall, the benefits of fish were strongest in men and persons without obesity.

Study Questions:

What is the relative incidence and mortality risk for cardiovascular diseases (CVDs) (CVD includes ischemic heart disease [IHD], myocardial infarction [MI], stroke, and heart failure [HF]) among people with different types of diets—including vegetarians, fish eaters, fish and poultry eaters, and meat-eaters—using data from the UK Biobank?


A total of 422,791 participants (55.4% women) were included in a prospective analysis. Using data from a food frequency questionnaire, four types of diets were derived. Associations between types of diets and health outcomes were investigated using Cox proportional hazard models.


Mean age was about 55 years. Meat-eaters comprised 94.7% of the cohort and were more likely to have at least one comorbidity including obesity and current smoking. After a median follow-up of 8.5 years, fish eaters, compared with meat-eaters, had lower risks of incident CVD (hazard ratio [HR], 0.93; 95% confidence interval [CI], 0.88–0.97), IHD (HR, 0.79; 95% CI, 0.70–0.88), MI (HR, 0.70; 95% CI, 0.56–0.88), stroke (HR, 0.79; 95% CI, 0.63–0.98), and HF (HR, 0.78; 95% CI, 0.63–0.97), after adjusting for confounders. Vegetarians had lower risk of total CVD incidence (HR, 0.91; 95% CI, 0.86–0.96) relative to meat-eaters. In contrast, the risk of adverse outcomes was not different in fish and poultry eaters compared with meat-eaters. No associations were identified between types of diets and CVD mortality.


Eating fish rather than meat or poultry was associated with a lower risk of a range of adverse cardiovascular outcomes. Vegetarianism was only associated with a lower risk of CVD incidence.


The data on the value of fish and omega-3 polyunsaturated fatty acids for reducing incident CVD keeps growing and is further supported by this study in the UK Biobank. But the results, which may be unique to the UK, are underpowered to assess the impact of the major source of protein on incident MI and stroke. Data are derived from a very low-risk middle-aged population in whom incident MI plus stroke over 8.5 years was only 3% in the reference group, of whom 95% were meat-eaters compared to 1% fish and poultry, 2.4% fish, and 1.8% vegetarians. Interestingly, it was speculated that the vegetarians did not fare as well because of the high consumption of potato chips.

Clinical Topics: Diabetes and Cardiometabolic Disease, Heart Failure and Cardiomyopathies, Prevention, Acute Heart Failure, Diet, Smoking

Keywords: Cardiovascular Diseases, Diet, Diet, Vegetarian, Fish Products, Heart Failure, Meat, Myocardial Infarction, Myocardial Ischemia, Obesity, Poultry, Primary Prevention, Smoking, Stroke, Vascular Diseases

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