The Association Between the Plant-Based Dietary Pattern and Cardiovascular Events Risk Across Various Cardiovascular Disease Risk Populations in Northern China: A Cross-Sectional and Longitudinal Analysis from the China PEACE Project.

Abstract

Background: Cardiovascular disease (CVD) represents a primary cause of mortality in China. A thorough comprehension of the relationship between dietary patterns and CVD risk, coupled with the identification of effective dietary interventions, constitutes a robust foundation for enhancing the primary prevention of CVD.

Objectives: This study aimed to investigate the associations between plant-based dietary indices (PDIs) and risk of CVD events among individuals with varying levels of CVD risk in northern China.

Methods: The data from the China Patient-centered Evaluative Assessment of Cardiac Events Project was collected during 2017-2020 in Shanxi provinces. A total of 54,764 residents aged 35-75 y were eligible and enrolled in the cross-sectional study and divided into the high CVD risk population (HCRP) and the nonhigh CVD risk population according to the WHO prediction for CVD risk. The PDI was derived from data collected via the Food Frequency Questionnaire. We examined the relationship between PDI and risk of cardiovascular events (CVEs) utilizing generalized estimating equations, restricted cubic spline models, and mediation effect models, with adjustments for covariates. Subsequently, multivariate-adjusted Cox regression models were employed to analyze the association between PDI and the incidence risk of CVEs in the HCRP cohort over the follow-up.

Results: The cross-sectional analysis revealed a negative and linear association between PDI and CVEs risk [odds ratio (OR) = 0.98; 95% confidence interval (CI): 0.97, 0.99] mediated by diabetes (β = -0.001) within the HCRP, characterized by an L-shaped relationship with a cut-off point of 47. Follow-up analysis indicated the higher PDI scores were associated with a lower incidence risk of CVEs in the subgroup with body mass index <24 kg/m² [P = 0.014; hazard ratio (HR) = 0.78; 95% CI: 0.56, 1.08].

Conclusions: The prevention and control of CVD should not exclusively emphasize plant-based diets. Instead, it is imperative to adopt a comprehensive dietary approach considering the diverse physical conditions.