Plant-Based Diets and Coronary Heart Disease Risk

Study Questions:

Are plant-based diet indices (PDIs) associated with fewer coronary heart disease (CHD) events?


Data from women in the Nurses’ Health Study (NHS) (1984-2012), Nurses’ Health Study 2 (NHS2) (1991-2013), and men in Health Professionals Follow-up Study (HPFS) (1986-2012) were used for the present analysis. All participants were free of chronic diseases at baseline. The investigators defined a PDI using semi-quantitative food-frequency questionnaire data. A healthful PDI was created and defined by healthy plant foods (whole grains, fruits/vegetables, nuts/legumes, oils, tea/coffee) receiving positive scores, while less-healthy plant foods (juices/sweetened beverages, refined grains, potatoes/fries, sweets) and animal foods received reverse scores. An unhealthful PDI was created by assigning positive scores to less-healthy plant foods and reverse scores to animal and healthy plant foods. The primary outcomes of interest were CHD.


A total of 73,710 women in the NHS, 92,329 women from the NHS2, and 43,259 men in the HPFS were included in the present analysis. Over 4,833,042 person-years of follow-up, 8,631 incident CHD cases were documented. In pooled multivariable analysis, higher adherence to PDI was associated with lower CHD (hazard ratio [HR] comparing extreme deciles, 0.92; 95% confidence interval [CI], 0.83-1.01; p trend = 0.003). A healthful PDI was more strongly associated with lower risk for CHD (HR, 0.75; 95% CI, 0.68-0.83; p trend < 0.001). In contrast an unhealthy PDI was associated with an increased risk for CHD (HR, 1.32; 95% CI, 1.20-1.46; p trend < 0.001).


The authors concluded that higher intake of a PDI rich in healthier plant foods is associated with substantially lower CHD risk, while a PDI that emphasizes less-healthy plant foods is associated with higher CHD risk.


These data support the concept that a healthy dietary pattern high in plant-based foods is associated with a lower incidence of CHD.

Keywords: Coffee, Coronary Artery Disease, Diet, Epidemiologic Studies, Fruit, Nuts, Oils, Plants, Edible, Primary Prevention, Risk, Sweetening Agents, Tea, Vegetables

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