Partial substitution of red or processed meat with plant-based foods and the risk of cardiovascular disease

Abstract

A shift towards more plant-based diets may promote human and planetary health. This modelling study aimed to assess the impact of moderate partial substitution of red or processed meat with plant-based foods on cardiovascular disease (CVD) risk. We used pooled data from five Finnish cohorts (42,868 participants aged ≥ 25 years, 78% men). Median follow-up time was 12.7 years, with 11,031 incident CVD cases. Diet was assessed by a validated food frequency questionnaire. We modelled substitutions of red meat (100 g/week) or processed meat (50 g/week) with corresponding amounts of plant-based foods. Cohort-specific hazard ratios (HR) and 95% confidence intervals (CI) were calculated using Cox proportional hazards multivariate models adjusted for relevant confounding factors and pooled together using a random effects model. There was a suggestive reduction in CVD risk in men when processed meat was substituted with vegetables or the combination of plant-based foods (HR 0.99, 95% CI 0.99–1.00, P < 0.05). In women, there was an increase in CVD risk when red meat was substituted with legumes (HR 1.10, 95% CI 1.01–1.20, P < 0.05). However, when all cohorts were followed for the same length of time (7.9 years), several plant-based foods reduced CVD risk and none of them increased the risk when partially replacing red or processed meat. Even a small, easily implemented change towards a more plant-based diet may contribute to cardiovascular health at the population level. These findings support global strategies towards healthy and environmentally sustainable diets.