Effects of a Lacto-Ovo-Vegetarian Diet on the Plasma Lipidome and Its Association with Atherosclerotic Burden in Patients with Coronary Artery Disease—A Randomized, Open-Label, Cross-over Study

Abstract

A vegetarian diet has been associated with a lower risk of coronary artery disease (CAD). Plasma triacylglycerols, ceramides, and phosphatidylcholines may improve prediction of recurrent coronary events. We sought to investigate effects of a lacto-ovo-vegetarian diet (VD) on plasma lipidome in CAD patients and simultaneously assess associations of plasma lipids with the extent of coronary atherosclerotic burden. We analyzed 214 plasma lipids within glycerolipid, sphingolipid, and sterol lipid classes using lipidomics from a randomized controlled, crossover trial comprising 31 CAD patients on standard medical therapy. Subjects completed a four-week intervention with VD and isocaloric meat diet (MD), separated by a four-week washout period. The VD increased levels of 11 triacylglycerols and lowered 7 triacylglycerols, 21 glycerophospholipids, cholesteryl ester (18:0), and ceramide (d18:1/16:0) compared with MD. VD increased triacylglycerols with long-chain polyunsaturated fatty acyls while decreased triacylglycerols with saturated fatty acyls, phosphatidylcholines, and sphingomyelins than MD. The Sullivan extent score (SES) exhibited on coronary angiograms were inversely associated with triacylglycerols with long-chain polyunsaturated fatty acyls. Phosphatidylcholines that were lower with VD were positively associated with SES and the total number of stenotic lesions. The VD favorably changed levels of several lipotoxic lipids that have previously been associated with increased risk of coronary events in CAD patients.

Vegan Diet Is Associated With Favorable Effects on the Metabolic Performance of Intestinal Microbiota: A Cross-Sectional Multi-Omics Study

“…Moreover, with respect to certain cancers, a strict vegan diet may be more beneficial than a lacto-ovo-vegetarian one, although further studies are needed (8,9). Intervention studies comparing vegan or vegetarian diets vs. omnivorous diets have shown beneficial effects of these diets on cardiometabolic risk factors (10), T2D (11), and obesity (12).…”

A Randomized Controlled Dietary Intervention Improved the Serum Lipid Signature towards a Less Atherogenic Profile in Patients with Rheumatoid Arthritis

“…Recently, bioactive lipids have also been discovered as independent risk factors for CVD. Concentrations of specific ceramides in serum have been shown to predict major cardiovascular events [ 3 , 4 , 5 ], and ratios of ceramides to associate with CVD death, independent of other risk factors [ 6 , 7 , 8 ]. For example, CERT2, a new risk score based on specific phosphatidylcholines and ceramides in serum, is a significant predictor of CVD mortality, as shown in several independent cohorts [ 9 , 10 , 11 ].…”

Ceramides in Autoimmune Rheumatic Diseases: Existing Evidence and Therapeutic Considerations for Diet as an Anticeramide Treatment

“…The results showed that in the two active interventions, a higher ceramide score did not coincide with a high CVD risk, however, in the control arm, an elevated ceramide score was associated with a significantly higher CVD risk [ 188 ]. Finally, an additional RCT revealed that adherence to a VD reduced the ceramide concentrations, compared to the standard medical nutrition therapy for patients with coronary artery disease [ 182 ].…”