Quality of plant-based diets in relation to 10-year cardiovascular disease risk: the ATTICA cohort study

Matina Kouvari; Thomas Tsiampalis; Christina Chrysohoou; Ekavi Georgousopoulou; John Skoumas; Christos S Mantzoros; Christos S Pitsavos; Demosthenes B Panagiotakos

doi:10.1007/s00394-022-02831-0

Quality of plant-based diets in relation to 10-year cardiovascular disease risk: the ATTICA cohort study

Eur J Nutr. 2022 Aug;61(5):2639-2649. doi: 10.1007/s00394-022-02831-0. Epub 2022 Mar 5.

Authors

Affiliations

¹ Biostatistics, Research Methods and Nutrition Epidemiology, School Of Health Science and Education, Department of Nutrition and Dietetics, Harokopio University, Athens, Greece.
² Faculty of Health, University of Canberra, Canberra, Australia.
³ First Cardiology Clinic, School of Medicine, University of Athens, Athens, Greece.
⁴ School of Medicine, The University of Notre Dame, Sydney, Australia.
⁵ Medical School, Australian National University, Canberra, Australia.
⁶ Department of Medicine, Boston VA Healthcare System and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02215, USA.
⁷ Biostatistics, Research Methods and Nutrition Epidemiology, School Of Health Science and Education, Department of Nutrition and Dietetics, Harokopio University, Athens, Greece. dbpanag@hua.gr.
⁸ Faculty of Health, University of Canberra, Canberra, Australia. dbpanag@hua.gr.

PMID: 35249127
DOI: 10.1007/s00394-022-02831-0

Abstract

Purpose: We prospectively evaluated the association between quality of plant-based diets and 10-year first fatal/non-fatal cardiovascular disease (CVD) incidence.

Methods: ATTICA study was conducted in the greater metropolitan Athens area, Greece, during 2001-2002 studying men and women (aged > 18 years old) free of CVD at baseline. Follow-up CVD assessment (2011-2012) was achieved in n = 2,020 participants (n = 317 cases). Dietary assessment was based on a validated semi-quantitative paper-based food frequency questionnaire. Overall, healthful, and unhealthful plant-based dietary indices (PDI, hPDI and uPDI) were calculated through a standard published procedure. The association between plant-based indices and CVD outcome has been evaluated via Cox regression analysis.

Results: The CVD event rate was 15.7% (n = 317) with a median follow-up time of 8.41 years. The highest (3^rd PDI tertile) vs. lowest (1st tertile) adherence to plant-based pattern-irrespective to healthfulness of food products consumed-was inversely associated with CVD (hazard ratio (HR) 0.56; 95% confidence interval (95% CI) 0.14, 2.25) yet the CI was wide. Ranking from 1st to 2nd and 3rd hPDI tertile the CVD event rate was 6.4%, 10.5% and 16.2%, respectively (p = 0.003). Multi-variable adjusted analysis revealed that participants assigned in 2nd and 3rd hPDI tertile had 47% (HR 0.53; 95% CI 0.25-1.08) and 68% (HR 0.32; 95% CI 0.16-0.63) lower risk to develop CVD compared with their 1st tertile counterparts. Conversely, a positive association between uPDI and CVD risk was revealed in dose-response analysis (HR_(per ₅ _units _increase _in _uPDI) 1.34; 95% CI 0.95-2.37)).

Conclusions: Quality of plant-based diets is important and needs to be considered, as not all plant-source foods have beneficial cardiovascular effects.

Keywords: Animal food; Food pattern; Heart disease; Nutrition; Plant-based diet; Primary care.

MeSH terms

Adolescent
Cardiovascular Diseases* / epidemiology
Cohort Studies
Diet
Diet, Vegetarian / methods
Female
Humans
Incidence
Male
Risk Factors