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Plant-based diets and the incidence of cardiovascular disease: the Million Veteran Program
  1. Yanping Li1,2,
  2. Dong D Wang1,3,
  3. Xuan-Mai T Nguyen1,4,
  4. Rebecca J Song1,5,
  5. Yuk-Lam Ho1,
  6. Frank B Hu2,3,
  7. Walter C Willett2,3,
  8. Peter W F Wilson6,7,
  9. Kelly Cho1,8,
  10. John Michael Gaziano1,8 and
  11. Luc Djousse1,8
  12. on behalf of the Million Veteran Program
  1. 1 Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, Massachusetts, USA
  2. 2 Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
  3. 3 The Channing Division for Network Medicine,Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
  4. 4 Carle Illinois College of Medicine, University of Illinois Urbana Champaign, Champaign, Illinois, USA
  5. 5 Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
  6. 6 Epidemiology and Genomic Medicine, Atlanta VA Medical Center, Atlanta, Massachusetts, USA
  7. 7 Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Atlanta, Georgia, USA
  8. 8 Division of Aging, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
  1. Correspondence to Dr Luc Djousse; ldjousse{at}rics.bwh.harvard.edu

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.

  • Dietary patterns

Data availability statement

Data cannot be shared publicly because of VA policies regarding data privacy and security. Data contain potentially identifying and sensitive patient information. All relevant summary level data are included in the manuscript. For investigators with appropriate authorisations within the Department of Veterans Affairs, requests for data access can be made.

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjnph-2021-000401

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    Data availability statement

    Data cannot be shared publicly because of VA policies regarding data privacy and security. Data contain potentially identifying and sensitive patient information. All relevant summary level data are included in the manuscript. For investigators with appropriate authorisations within the Department of Veterans Affairs, requests for data access can be made.

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    Footnotes

    • YL, DDW and X-MTN contributed equally.

    • Contributors YL, DDW, X-MTN, FBH, WCW and LD were involved in the study conception and design. X-MTN, PWFW, KC, JMG and LD on behalf of the Million Veteran Program obtained funding and provided study materials and data. YL, DDW, X-MTN, RJS and Y-LH were involved in analysis and interpretation of the data. YL drafted the article; All authors revised it critically for important intellectual content and approved the final version. YL, DDW, X-MTN and LD are the guarantors.

    • Funding This research is based on data from the VA Million Veteran Program, Office of Research and Development, Veterans Health Administration, and was funded by award MVP#000 and BX004821.

    • Disclaimer None of the authors have financial conflicts of interest with the work reported in this manuscript. This publication does not represent the views of the Department of Veterans Affairs or the US government.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally reviewed by Dr. Ilona Csizmadi, Cedars-Sinai Medical Center, Los Angeles California, USA and by Dr. Pao-Hwa Lin, Duke University Medical Center, North Carolina, United States.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.