The Association Between the Plant-based Dietary Pattern and Cardiovascular Events Risk Across Various Cardiovascular Risk Populations in Northern China: a cross-sectional and Longitudinal Analysis from the China PEACE project.

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

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

Methods: The data from the China PEACE (Patient-centered Evaluative Assessment of Cardiac Events) Project is being conducted during 2017-2020 in Shanxi provinces. A total of 54,764 residents aged 35-75 years were eligible enrolled in the cross-sectional study and divided into the high CVD risk population (HCRP) and the non-high CVD risk population (NCRP) according to the WHO prediction for CVD risk. The PDI was derived from data collected via the Food Frequency Questionnaire (FFQ). We examined the relationship between PDI and the 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 (OR=0.98, 95% 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 BMI < 24 kg/m² (P =0.014, 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.

Registry and registry number: The PEACE project, which received approval from the Ethics Committee of Fu Wai Hospital, Chinese Academy of Medical Sciences (Approval Code: 2014-574) STATEMENT OF SIGNIFICANCE: The data utilized in this study were sourced from the national survey initiative, the China Patient-centered Evaluative Assessment of Cardiac Events (PEACE). This research constitutes the inaugural exploration of the association between dietary patterns and the risk of cardiovascular events (CVEs) within Shanxi Province. Notably, the study encompassed individuals exhibiting a range of cardiovascular risk levels, thereby demonstrating its comprehensive scope. The enrolled participants, referred to as the entire population (EP), were categorized into two groups: the high cardiovascular disease risk group (HCRP) and the non-high cardiovascular disease risk group (NCRP). The study analyzed the relationship between dietary plant-based dietary index (PDI) and CVD risk within these three populations: the entire population (EP), HCRP, and NCRP(non-high CVD population). Notably, the research elucidates the association between plant-based dietary patterns and the incidence of cardiovascular events (CVEs) in the HCRP. The findings hold practical significance and provide valuable reference points for the prevention and management of CVD. Additionally, the study comprised both a cross-sectional study and a follow-up study. The cross-sectional study examined the relationship between PDI and the risk of CVD among subjects with varying levels of CVD risk. Furthermore, the relationship between PDI and the incidence of CVD was explored within the target population (high CVD risk population), with the aim of providing dietary recommendations for the prevention and control of CVD.