One of the largest studies on what is good (and bad) for heart disease prevention has just been published in the Journal of the American College of Cardiology. This study (Satija 2017) conducted by the Harvard T.H. Chan School of Public Health (Boston, USA) is an analysis of three studies (Nurses’ Health Study, Nurses Health Study 2, and Health Professionals Follow-up Study).
Healthy plant foods lower heart disease risk.
Unhealthy plant foods increase heart disease risk.
Animal products (viewed as on big group) increase heart disease risk – see note below (Satija 2017).
Effect of CHD (coronary heart disease) risk
more healthy plant foods
less unhealthy plant foods
less animal products
25% decrease in CHD
more unhealthy plant foods
less healthy plant foods
less animal products
32% increase in CHD
Healthy plant foods
- Whole grains: Whole grain breakfast cereal, other cooked breakfast cereal, cooked oatmeal, dark bread, brown rice, other grains, bran, wheat germ, popcorn
- Fruits: Raisins or grapes, prunes, bananas, cantaloupe, watermelon, fresh apples or pears, oranges, grapefruit, strawberries, blueberries, peaches or apricots or plums
- Vegetables: Tomatoes, tomato juice, tomato sauce, broccoli, cabbage, cauliflower, brussels sprouts, carrots, mixed vegetables, yellow or winter squash, eggplant or zucchini, yams or sweet potatoes, spinach cooked, spinach
raw, kale or mustard or chard greens, iceberg or head lettuce, romaine or leaf lettuce, celery, mushrooms, beets, alfalfa sprouts, garlic, corn
- Nuts: Nuts, peanut butter
- Legumes: String beans, tofu or soybeans, beans or lentils, peas or lima beans
- Vegetable oils: Oil-based salad dressing, vegetable oil used for cooking
- Tea and coffee: Tea, coffee, decaffeinated coffee
Less healthy plant foods
- Fruit juices: Apple cider (nonalcoholic) or juice, orange juice, grapefruit juice, other fruit juice
- Refined grains: Refined grain breakfast cereal, white bread, English muffins or bagels or rolls, muffins or biscuits, white rice, pancakes or waffles, crackers, pasta
- Potatoes: French fries, baked or mashed potatoes, potato or corn chips
- Sugar sweetened beverages: Colas with caffeine and sugar, colas without caffeine but with sugar, other carbonated beverages with sugar, noncarbonated fruit drinks with sugar
- Sweets and desserts: Chocolates, candy bars, candy without chocolate, cookies (home-baked and ready-made), brownies, doughnuts, cake (home-baked and ready-made), sweet roll (home-baked and ready-made), pie (home-baked and readymade), jams or jellies or preserves or syrup or honey
Animal products (as one group)
- Animal fat: Butter added to food, butter or lard used for cooking
- Dairy*: Skim low fat milk, whole milk, cream, sour cream, sherbet, ice cream, yogurt, cottage or ricotta cheese, cream cheese, other cheese
- Egg*: Eggs
- Fish* or seafood: Canned tuna, dark meat fish, other fish, shrimp or lobster or scallops
- Meat: Chicken or turkey with skin, chicken or turkey without skin, bacon, hot dogs, processed meats, liver, hamburger, beef or pork or lamb mixed dish, beef
or pork or lamb main dish
- Miscellaneous animal-based foods: Pizza, chowder or cream soup, mayonnaise or other creamy salad dressing
*Note that “healthy animal foods [such as] dairy except ice cream, egg, and fish” did not seem to have this negative effect on heart disease risk.
“[W]e found that even a slightly lower intake of animal foods combined with higher intake of healthy plant foods is associated with lower CHD risk.” (Satija 2017)
“Medical and health professionals should guide patients to increase intake of healthy plant foods, such as whole grains, fruits, vegetables, and nuts, and reduce intake of animal foods and less healthy plant foods such as SSB [sugar sweeted beverages] for CHD prevention.” (Satija 2017)
A comment on this study:
“This study adds to the evidence of gradations of adherence to an overall PDI [more plants, less animal products] with CHD incidence, such that one could propose a risk-based approach to PDI prescription: secondary prevention after cardiovascular events and patients at high risk having a stronger recommendation for a strictly hPDI [more healthy plant foods, less unhealthy plant foods, less animal products]. They [these studies here] cannot address the benefits of a purely plant-based diet (vegan) because this was a very small population in their study.
Substantial evidence indicates that a predominantly plant-based diet is associated with improved
cardiovascular risk factors, reduced incidence, and progression of CHD. Not all plant-based foods are
equally healthy; rather, plant-based diets including whole grains as the main form of carbohydrate, unsaturated fats as the predominate form of dietary fat, an abundance of fruit and vegetables, and adequate n-3 fatty acids can play an important role in preventing CVD. Such diets, which have many other health benefits including the prevention of several chronic diseases, deserve more emphasis in dietary recommendations.
If, for example, widespread adoption of plant-based nutrition reduced the incidence of hypertension to 25% of the current rate, this could result in savings of nearly 30% of the Medicare budget.
What, then, does hPDI [more healthy plant foods, less unhealthy plant foods, less animal products] really mean? It means both a challenge and an opportunity for cardiology. Until recently, as a group, cardiologists have not delved deeply into nutrition, treating CVD’s downstream effects rather than obliterating its roots, leaving primary and secondary prevention opportunities on the table.
It is time that we educate ourselves on dietary patterns, risk, and outcomes, and focus more on “turning off the faucet” instead of “mopping up the floor”.”
Dr. Kim Allan Williams Sr., Division of Cardiology, Rush University (Chicago, USA) (Williams 2017)
Satija A et al.: Healthful and Unhealthful Plant-Based Diets and the Risk of Coronary Heart Disease in U.S. Adults. J Am Coll Cardiol. 2017 Jul 25;70(4):411-422. doi: 10.1016/j.jacc.2017.05.047
Williams KA Sr, Patel H: Healthy Plant-Based Diet: What Does it Really Mean? J Am Coll Cardiol. 2017 Jul 25;70(4):423-425. doi: 10.1016/j.jacc.2017.06.006