Plant-Based Diets Reduce Cardiovascular Disease Risk: Insights from Long-Term Studies

Eating more nutritious, plant-based foods supports heart health at any age. Two studies examining healthy plant-based diets found that young adults and postmenopausal women experienced fewer heart attacks and lower cardiovascular disease risk when prioritizing these foods.

The American Heart Association recommends a balanced diet rich in fruits, vegetables, whole grains, low-fat dairy, skinless poultry, fish, nuts, legumes, and non-tropical vegetable oils. It advises limiting saturated fats, trans fats, sodium, red meat, sweets, and sugary drinks.

These studies assessed whether sustained plant-based eating from young adulthood correlates with reduced cardiovascular disease risk later in life.

“Prior research often focused on single nutrients or foods, but data on overall plant-based diets and long-term heart disease risk has been limited,” said lead author Yuni Choi, Ph.D., a postdoctoral researcher at the University of Groningen and formerly at the University of Minnesota School of Public Health in Minneapolis.

Choi and colleagues analyzed diets and heart disease outcomes in 4,946 adults from the Coronary Artery Risk Development in Young Adults (CARDIA) study. Participants, aged 18-30 at baseline (1985-1986), were cardiovascular disease-free initially: 2,509 Black adults and 2,437 white adults (54.9% women), stratified by education (more than high school vs. high school or less). Eight follow-ups from 1987-88 to 2015-16 captured lab tests, physical exams, medical history, and lifestyle data. Unlike controlled trials, this observational design yielded unbiased, long-term dietary habits.

Diet quality was scored via the A Priori Diet Quality Score (APDQS) from 46 food groups at years 0, 7, and 20. Foods were categorized as beneficial (fruits, vegetables, beans, nuts, whole grains), unfavorable (baked potatoes, high-fat red meat, salty snacks, baked goods, sodas), or neutral (potatoes, refined grains, lean meats, shellfish) based on cardiovascular links.

Higher scores reflected diverse beneficial plant foods and fewer unfavorable ones, indicating nutrient-rich, plant-forward diets.

Key findings:

• Over 32 years, 289 participants developed cardiovascular disease (heart attack, stroke, heart failure, angina, or clogged arteries).
• Top 20% scorers (most nutrient-rich plant foods, fewest poor animal products) had 52% lower risk, adjusting for age, sex, race, calories, education, family history, smoking, and activity.
• Those improving diet most from years 7-20 (ages 25-50), by increasing beneficial plants and cutting poor animal foods, faced 61% lower subsequent risk versus those declining most.
• Few vegetarians participated, so strict vegetarian benefits (no meat, dairy, eggs) weren't evaluated.

“A nutrient-dense plant-based diet promotes cardiovascular health—it doesn't require strict vegetarianism,” Choi noted. “Opt for minimally processed plant foods. Moderate animal products like non-fried poultry, fish, eggs, and low-fat dairy are fine occasionally.”