Association of plant-based diets with subclinical cardiovascular disease in U.S. adults, 1999-2004

Background

Dietary patterns currently recommended for cardiovascular health often emphasize the consumption of plant foods.

Methods

We included 7,708 participants from the National Health and Nutrition Examination Survey 1999-2004 aged ≥20 years who were not pregnant and did not have a self-reported history of cardiovascular disease. Dietary intake was assessed using a 24-hour dietary recall. All plant-based dietary indices [overall plant-based diet index (PDI), healthy PDI (hPDI), and unhealthy PDI (uPDI)] were analyzed by quartiles and cardiac biomarkers [cardiac troponin T (cTnT), cardiac troponin I (cTnI), and N-terminal pro-B-type natriuretic peptide (NT-proBNP)] were categorized as elevated versus non-elevated using clinical cutpoints. We used logistic regression models progressively adjusted for confounders to study the associations between each plant-based diet index and elevated cardiac biomarkers. All analyses used appropriate survey weights to account for the complex study design.

Results

Mean age was 45 years old, 46 % were male, and 74 % were non-Hispanic White. After adjustment for sociodemographic characteristics, lifestyle behaviors, and measures of health status, there was an inverse association between adherence to hPDI (quartile 4 vs. quartile 1) and elevated cTnI (OR: 0.52, 95 % CI: 0.30, 0.90; p-trend <0.01) and a positive association between uPDI and elevated cTnI (OR for quartile 4 vs. 1: 1.65, 95 % CI: 1.10, 2.46; p-trend=0.04). There were no significant associations between plant-based diet indices and elevated cTnT or NT-proBNP.

Conclusion

Higher adherence to a healthy plant-based diet was inversely associated with elevated cTnI and higher adherence to an unhealthy plant-based diet was positively associated with elevated cTnI in a nationally representative sample of U.S. adults. Supporting access to and adoption of healthy plant-based diets may be a useful strategy for promoting population-level cardiovascular health.