Plant-based diets and the incidence of cardiovascular disease: the Million Veteran Program

Yanping Li; Dong D Wang; Xuan-Mai T Nguyen; Rebecca J Song; Yuk-Lam Ho; Frank B Hu; Walter C Willett; Peter W F Wilson; Kelly Cho; John Michael Gaziano; Luc Djousse

doi:10.1136/bmjnph-2021-000401

Plant-based diets and the incidence of cardiovascular disease: the Million Veteran Program

BMJ Nutr Prev Health. 2023 Dec;6(2):212-220. doi: 10.1136/bmjnph-2021-000401. Epub 2023 Oct 25.

Authors

Yanping Li^#^{1

2}, Dong D Wang^#^{1

3}, Xuan-Mai T Nguyen^#^{1

4}, Rebecca J Song^{1

5}, Yuk-Lam Ho¹, Frank B Hu^{2

3}, Walter C Willett^{2

3}, Peter W F Wilson^{6

7}, Kelly Cho^{1

8}, John Michael Gaziano^{1

8}, Luc Djousse^{1

8}

Affiliations

¹ Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, Massachusetts, USA.
² Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
³ The Channing Division for Network Medicine,Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.
⁴ Carle Illinois College of Medicine, University of Illinois Urbana Champaign, Champaign, Illinois, USA.
⁵ Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA.
⁶ Epidemiology and Genomic Medicine, Atlanta VA Medical Center, Atlanta, Massachusetts, USA.
⁷ Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Atlanta, Georgia, USA.
⁸ Division of Aging, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.

^# Contributed equally.

Abstract

Background: A healthful plant-based diet was associated with lower risks of coronary heart disease and type 2 diabetes, and a favourable profile of adiposity-associated biomarkers, while an unhealthful plant-based diet was associated with elevated risk of cardiometabolic disease in health professional populations. However, little is known about the associations between plant-based dietary patterns and risk of cardiovascular disease (CVD) in US veterans.

Methods: The study population consisted of 148 506 participants who were free of diabetes, CVD and cancer at baseline in the Veterans Affairs (VA) Million Veteran Program. Diet was assessed using a Food Frequency Questionnaire at baseline. We calculated an overall Plant-Based Diet Index (PDI), a healthful PDI (hPDI) and an unhealthful PDI (uPDI). The CVD endpoints included non-fatal myocardial infarction (MI) and acute ischaemic stroke (AIS) identified through high-throughput phenotyping algorithms approach and fatal CVD events identified by searching the National Death Index.

Results: With up to 8 years of follow-up, we documented 5025 CVD cases. After adjustment for confounding factors, a higher PDI was significantly associated with a lower risk of CVD (HR comparing extreme quintiles=0.75, 95% CI 0.68 to 0.82, P _trend<0.0001). We observed an inverse association between hPDI and the risk of CVD (HR comparing extreme quintiles=0.71, 95% CI 0.64 to 0.78, P _trend<0.001), whereas uPDI was positively associated with the risk of CVD (HR comparing extreme quintiles=1.12, 95% CI 1.02 to 1.24, P _trend<0.001). We found similar associations of hPDI with subtypes of CVD; a 10-unit increment in hPDI was associated with HRs (95% CI) of 0.81 (0.75 to 0.87) for fatal CVD, 0.86 (0.79 to 0.94) for non-fatal MI and 0.86 (0.78 to 0.95) for non-fatal AIS.

Conclusions: Plant-based dietary pattern enriched with healthier plant foods was associated with a substantially lower CVD risk in US veterans.

Keywords: Dietary patterns.

Abstract

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