Erasmus University Medical Center Rotterdam, Zuid-Holland, Netherlands
Objectives: We investigated associations of plant-based diet indices (PDIs) with incident CVDs in a prospective cohort study and conducted an updated meta-analysis.
Methods: We included 3,507 men and 5,345 women of the population-based Rotterdam Study. Multivariable Cox proportional hazard models adjusting for age, energy intake, food supplement use, and other lifestyle factors, history of diseases and medication use were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for CVD, coronary heart disease (CHD) and stroke per SD increment of an overall PDI, healthy PDI (hPDI) and unhealthy PDI (uPDI), and potential effect modification by sex was evaluated. We used restricted cubic splines to assess potential non-linear associations. Moreover, we conducted an updated meta-analysis of the PDI, hPDI and uPDI with composite CVD incidence; synthesizing the evidence to date to incorporate our novel findings in the Rotterdam Study, and further strengthening the evidence from previous meta-analyses by standardizing effect estimates (CIs) reported by previous studies, to allow direct comparison of results presented on different exposure scales.
Results: We documented 2,015 CVD cases (1,231 CHD,952 stroke) during 107,290 person-years follow-up. Among men, the PDI and hPDI were associated with a 7% (HR 0.93, 95% CI 0.87-0.99) and 8% (HR 0.92, 95% CI 0.86-0.98) lower CVD risk. Among women, data suggested a U-shaped association of the PDI with stroke (pnon-linearity < 0.01). In meta-analyses including up to 37,494 incident CVD cases among 370,257 participants from eight studies, the PDI and hPDI, but not uPDI, were associated with a lower CVD risk (pooled HRs [95% CI], per SD, PDI: 0.95 [0.91-0.99], I2 = 48.5%; hPDI: 0.96 [0.93-0.99], I2 = 70%).
Conclusions: Our findings based on this largest meta-analysis to date support recommendations to consume relatively more healthy plant-based foods for CVD prevention. Potential differences by sex and non-linear associations warrant further investigation.
Funding Sources: The Rotterdam Study is funded by Erasmus MC, Erasmus University, ZonMw, the Dutch government and municipality of Rotterdam. XJW received a Chinese Scholarship Council scholarship.
