Association of Healthy Predominantly Plant-Based Diet with Reduced Cardiovascular Disease Incidence and Mortality and Development of Novel Heart-Protective Diet Index †

Abstract

Background: Previous research examining the effects of omnivorous and plant-based diets on cardiovascular disease (CVD) outcomes has produced inconsistent findings, and the importance of diet quality is overlooked. Our study aimed to develop a novel heart-protective diet index to assess the association of a high-quality, predominantly plant-based diet—including fish, eggs, and low-fat dairy products—with CVD incidence and mortality. Methods: This study included 192,274 participants in the UK Biobank (mean age: 56.3 ± 7.9 years) without CVD at baseline who completed a 24 h recall Oxford WebQ questionnaire. Using the Oxford WebQ questionnaire, we developed and validated a novel heart-protective diet score (HPDS) based on 22 food groups. Cox proportional hazard models were used to study the associations between HPDS and outcomes. Results: During a median follow-up of 12.3 years, 20,692 CVD events and 1131 CVD deaths were observed. After adjusting for demographics, Townsend deprivation index, lifestyle, and history of chronic diseases, participants in the top HPDS quartile were at lower risk, compared to those in the bottom quartile, of overall CVD (HR: 0.92 [95%CI: 0.88, 0.95]), IHD (HR: 0.89 [95%CI: 0.84, 0.94]), MI (HR: 0.85 [95%CI: 0.77, 0.94]), and HF (HR: 0.86 [95%CI: 0.77, 0.95]). Conclusions: Adherence to a healthy, predominantly plant-based heart-protective diet rich in non-starchy vegetables, fruits, wholegrains, fish, eggs, and low-fat dairy products is associated with a reduced cardiovascular disease incidence and mortality. Further research in diverse ethnic populations is necessary to examine the reproducibility of our findings and enhance generalizability.