(P29-047-23) Healthy and Unhealthy Plant-Based Diets and the Risk of Cardiovascular Diseases: Results From the Rotterdam Study and an Updated Meta-Analysis

Objectives: We investigated the association of plant-based diets (containing relatively more plant-based, and less animal-based foods) with incident cardiovascular diseases (CVDs), coronary heart disease (CHD) and stroke, and whether associations differed by adherence to healthful and less healthful plant-based diets, through an updated meta-analysis including original results from the Rotterdam Study.

Methods: We included 8,852 participants of the population-based Rotterdam Study (RS) without prevalent CVD at baseline (1989–2006). To simultaneously reflect diets higher in plant-based foods and lower in animal-based foods, an overall plant-based diet index (PDI) was created by scoring plant-food groups positively and animal-food groups negatively. Additionally, a ‘healthy’ PDI (hPDI) and an ‘unhealthy’ PDI (uPDI) were developed, giving positive scores for the healthy plant-food groups only and less healthy plant-food groups only, respectively. Multivariable Cox hazard regression models were used to assess the associations of adherence to each of the three PDI scores, as well as plant and animal food categories, with incident CVD, CHD and stroke. We also combined our findings in the Rotterdam Study with those from published cohort investigations in an updated random-effects meta-analysis to estimate the pooled HR (95% CI) of incident CVD for the PDI, hPDI and uPDI score.

Results: We observed no evidence for associations of the PDI, hPDI or uPDI with incident CVD, CHD or stroke in the Rotterdam Study alone, but the highest vs. lowest quintiles of consuming foods in the healthy plant-food category was associated with a lower risk of incident CVD with HR (95% CI) being 0.84 (0.73-0.98) (plinear trend = 0.02). In meta-analyses of up to 368,922 participants including up to 31,637 incident CVD cases, the PDI and hPDI were associated with lower CVD incidence (pooled HR for extreme quintiles: 0.86, 95% CI: 0.76-0.97, I2 = 49.7%, p = 0.09; 0.85, 0.75-0.96, I2 = 72.1%, p < 0.01). There was no evidence for association of the uPDI with CVD.

Conclusions: A shift towards diets containing more healthy plant foods and less animal foods should be advocated for cardiovascular health prevention.

Funding Sources: Erasmus Medical Center and Erasmus University, China Scholarship Council