Further research builds upon the association of a vegetarian diet and lower risk of CVD and suggests that people adhering to a vegetarian diet have lower CVD mortality rates than do non-vegetarians. One prospective study involving 44,561 men and women from England and Scotland found that the vegetarian segment of the study population had a 32% (HR, 0.68) lower risk of ischemic heart disease (IHD) than did the non-vegetarians in the study, even after adjusting for factors such as age, smoking, alcohol, and physical activity.23
After adjusting for BMI, vegetarians still showed a 28% (HR, 0.72) lower risk of IHD than did non-vegetarians. The probability of hospitalization or death due to IHD was 4.6% for vegetarians, compared with 6.8% for non-vegetarians.
In congruence with those data, a meta-analysis of five prospective studies found that vegetarians had a 29% (RR, 0.71) lower mortality rate from IHD than did non-vegetarians.24 In another example, a study of 73,308 men and women found that all types of vegetarians (semi-vegetarians, pesco-vegetarians, lacto-ovo vegetarians, and vegans) had significantly lower mortality rates compared with non-vegetarians.25
A strength of this study was that all the subjects followed the same conservative religious principles of the Seventh-day Adventist Church, thereby reducing variables outside of their diet (such as tobacco and alcohol use) that may have led to poor health outcomes.
The group was almost evenly split: 51.8% were vegetarian and 48.2% were non-vegetarian. The non-vegetarian mortality rate was 6.61 deaths per 1,000 person-years; pesco-vegetarians had the lowest mortality rate at 5.33 deaths per 1,000 person-years. Mortality from CVD and IHD were significantly reduced for male vegetarians.
Numerous studies have proven that a vegetarian diet can decrease a person’s risk of heart disease by reducing risk factors such as high cholesterol, high blood pressure, diabetes, and obesity, and can even reverse lesions of occlusive coronary artery disease.
Moreover, patients at risk of CHD who adopt a vegetarian diet or modify their current diet by reducing meat intake can often reduce or even prevent the need for medications, thereby avoiding related adverse side effects.
Given the shift in our health-care model toward preventive medicine, interventions such as dietary modification to reduce the risk of CVD will be vitally important. Patients should be encouraged at every opportunity to make positive lifestyle changes. Those who are serious about changing their diets as part of a comprehensive treatment plan would likely benefit from referral to a registered dietitian.
In addition, several websites serve as good resources for information on vegetarian diets, including the Vegetarian Nutrition Dietetic Practice Group of the Academy of Nutrition and Dietetics, The Vegetarian Resource Group, the Jesse & Julie Rasch Foundation’s nutritionfacts.org, and the Mayo Clinic’s “Nutrition and healthy eating” page.
Allison Nichols, PA-C, is a resident in the Physician Assistant Residency Program for Cardiothoracic Surgery at St. Joseph Mercy Hospital in Ann Arbor, Mich.
John Grosel, MD, is an associate professor in the Physician Assistant Program at Marietta College in Marietta, Ohio, and a radiologist with Riverside Radiology and Interventional Associates, Inc., in Columbus, Ohio.
- Heart disease and stroke prevention. Centers for Disease Control and Prevention website. www.cdc.gov/chronicdisease/resources/publications/AAG/dhdsp.htm
- D’Agostino RB Sr, Vasan RS, Pencina MJ, et al. General cardiovascular risk profile for use in primary care: the Framingham Heart Study. Circulation. 2008;117(6):743-753. Available at circ.ahajournals.org/content/117/6/743.long
- Saxena N, Singh SP, Raizada A. A comparative study on parameters of lipid metabolism and fasting blood sugar in normal vegetarians and non-vegetarians. JARBS. 2012;4(4): 306-311. Available at www.scopemed.org/?mno=29697#cite
- Gardner CD, Coulston A, Chatterjee L, et al. The effect of a plant-based diet on plasma lipids in hypercholesterolemic adults: a randomized trial. Ann Intern Med. 2005;142(9):725-733.
- Jenkins DJ, Kendall CW, Marchie A, et al. Effects of a dietary portfolio of cholesterol-lowering foods vs lovastatin on serum lipids and C-reactive protein. JAMA. 2003;290(4):502-510. Available at jama.jamanetwork.com/article.aspx?articleid=196970
- Jenkins DJ, Jones PJ, Lamarche B, et al. Effect of a dietary portfolio of cholesterol-lowering foods given at 2 levels of intensity of dietary advice on serum lipids in hyperlipidemia: a randomized controlled trial. JAMA. 2011;306(8):831-839. Available at jama.jamanetwork.com/article.aspx?articleid=1104262
- Jenkins DJ, Wong JM, Kendall CW, et al. The effect of a plant-based low-carbohydrate (“Eco-Atkins”) diet on body weight and blood lipid concentrations in hyperlipidemic subjects. Arch Intern Med. 2009;169(11):1046-1054. Available at archinte.jamanetwork.com/article.aspx?articleid=415074
- Pettersen BJ, Anousheh R, Fan J, et al. Vegetarian diets and blood pressure among white subjects: results from the Adventist Health Study-2 (AHS-2). Public Health Nutr. 2012;15(10):1909-1916. Available at www.ncbi.nlm.nih.gov/pmc/articles/PMC3443300
- Appleby PN, Davey GK, Key TJ. Hypertension and blood pressure among meat eaters, fish eaters, vegetarians, and vegans in EPIC-Oxford. Public Health Nutr. 2002;5(5):645-654. Available at dx.doi.org/10.1079/PHN2002332
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- Tonstad S, Butler T, Yan R, Fraser GE. Type of vegetarian diet, body weight, and prevalence of type 2 diabetes. Diabetes Care. 2009;32(5):791-796. Available at care.diabetesjournals.org/content/32/5/791.long
- Valachovičová M, Krajčovičová-Kudláčková M, Blažíček P, Babinská K. No evidence of insulin resistance in normal weight vegetarians. A case control study. Eur J Nutr. 2006;45(1):52-54.
- Barnard ND, Cohen J, Jenkins DJ, et al. A low-fat vegan diet improves glycemic control and cardiovascular risk factors in a randomized clinical trial in individuals with type 2 diabetes. Diabetes Care. 2006;29(8):1777-1783. Available at care.diabetesjournals.org/content/29/8/1777.long
- Turner-McGrievy GM, Barnard ND, Cohen J, et al. Changes in nutrient intake and dietary quality among participants with type 2 diabetes following a low-fat vegan diet or a conventional diabetes diet for 22 weeks. J Am Diet Assoc. 2008;108(10):1636-1645.
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- Pan A, Sun Q, Bernstein AM, et al. Red meat consumption and mortality: results from 2 prospective cohort studies. Arch Intern Med. 2012;172(7):555-563. Available at archinte.jamanetwork.com/article.aspx?articleid=1134845
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- Bhupathiraju SN, Wedick NM, Pan A, et al. Quantity and variety in fruit and vegetable intake and risk of coronary heart disease. Am J Clin Nutr. 2013;98(6):1514-1523.
- Rankin P, Morton DP, Diehl H, et al. Effectiveness of a volunteer-delivered lifestyle modification program for reducing cardiovascular disease risk factors. Am J Cardiol. 2012;109(1):82-86.
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- Crowe FL, Appleby PN, Travis RC, Key TJ. Risk of hospitalization or death from ischemic heart disease among British vegetarians and non-vegetarians: results from the EPIC-Oxford cohort study. Am J Clin Nutr. 2013;97(3):597-603. Available at ajcn.nutrition.org/content/97/3/597.long
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All electronic documents accessed July 18, 2014.
This article originally appeared on Clinical Advisor