Relationship Between a Plant‐Based Dietary Portfolio and Risk of Cardiovascular Disease: Findings From the Women's Health Initiative Prospective Cohort Study

Abstract

Background The plant‐based Dietary Portfolio combines established cholesterol‐lowering foods (plant protein, nuts, viscous fiber, and phytosterols), plus monounsaturated fat, and has been shown to improve low‐density lipoprotein cholesterol and other cardiovascular disease (CVD) risk factors. No studies have evaluated the relation of the Dietary Portfolio with incident CVD events. Methods and Results We followed 123 330 postmenopausal women initially free of CVD in the Women's Health Initiative from 1993 through 2017. We used Cox proportional‐hazard models to estimate adjusted hazard ratios (HRs) and 95% CI of the association of adherence to a Portfolio Diet score with CVD outcomes. Primary outcomes were total CVD, coronary heart disease, and stroke. Secondary outcomes were heart failure and atrial fibrillation. Over a mean follow‐up of 15.3 years, 13 365 total CVD, 5640 coronary heart disease, 4440 strokes, 1907 heart failure, and 929 atrial fibrillation events occurred. After multiple adjustments, adherence to the Portfolio Diet score was associated with lower risk of total CVD (HR, 0.89; 95% CI, 0.83–0.94), coronary heart disease (HR, 0.86; 95% CI, 0.78–0.95), and heart failure (HR, 0.83; 95% CI, 0.71–0.99), comparing the highest to lowest quartile of adherence. There was no association with stroke (HR, 0.97; 95% CI, 0.87–1.08) or atrial fibrillation (HR, 1.10; 95% CI, 0.87–1.38). These results remained statistically significant after several sensitivity analyses. Conclusions In this prospective cohort of postmenopausal women in the United States, higher adherence to the Portfolio Diet was associated with a reduction in incident cardiovascular and coronary events, as well as heart failure. These findings warrant further investigation in other populations.

Adherence to a Plant-Based Diet and Consumption of Specific Plant Foods—Associations with 3-Year Weight-Loss Maintenance and Cardiometabolic Risk Factors: A Secondary Analysis of the PREVIEW Intervention Study

“…On the contrary, Satija et al [24,27,31] and Chen et al [32] showed that an overall PDI was associated with smaller weight change or lower risk of T2D and coronary heart disease in three US prospective cohort studies. In addition, Glenn et al [33] found that a plant-based Portfolio Diet was associated with a reduced CVD risk in the Women's Health Initiative Prospective Cohort.…”

Prospective Association of the Portfolio Diet with All-Cause and Cause-Specific Mortality Risk in the Mr. OS and Ms. OS Study

“…To the best of our knowledge, this study is the first to demonstrate the potential role of the Portfolio Diet in preventing all-cause mortality; therefore, comparison with other literature is challenging. An analysis of postmenopausal women that participated in the WHI showed that the adherence to the Portfolio Diet was associated with lower risk of total CVD (HR: 0.89, 95% CI: 0.83, 0.94), coronary heart disease (HR: 0.86, 95% CI: 0.78, 0.95), and heart failure (HR: 0.83, 95% CI: 0.71, 0.99), comparing the highest to lowest quartile of adherence [10], which is not in line with the findings from our study. In other words, the relatively small sample size (3991 older adults when compared with 123,330 postmenopausal women in WHI) for the present study might limit the statistical power to detect associations between PDS and CVD mortality.…”

“…In addition to clinical trials for patients with dyslipidemia, the health benefits of the Portfolio Diet were also examined among cohort studies. A Portfolio Diet score (PDS) has been developed and validated to assess the adherence to the Portfolio Diet using food frequency questionnaires (FFQ) [8], and to date, the PDS has been associated with lower cardiometabolic risk factors in the Prevención con Dieta Mediterránea (PREDIMED)-Plus cohort and lower risk of CVD in the Women's Health Initiative (WHI) [9,10].…”

Cardiovascular Benefits of Plant-Based Diets

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Increasing evidence suggests that plant-based dietary patterns, characterized by higher intake of plant foods and lower intake of animal foods, confer benefits to cardiovascular health. [1][2][3][4] Vegetarian diets are a subset of plant-based diets that exclude some or all animal products (vegan diets). 5A meta-analysis of 86 cross-sectional and 10 cohort prospective studies evaluated the association between vegetarian, vegan diets, risk factors for chronic diseases, risk of all-cause mortality, incidence, and mortality from cardio-cerebrovascular diseases.

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“…Increasing evidence suggests that plant-based dietary patterns, characterized by higher intake of plant foods and lower intake of animal foods, confer benefits to cardiovascular health. [1][2][3][4] Vegetarian diets are a subset of plant-based diets that exclude some or all animal products (vegan diets). 5…”