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. 2020 Jul 1;112(1):220-228.
doi: 10.1093/ajcn/nqaa107.

Genetic susceptibility, plant-based dietary patterns, and risk of cardiovascular disease

Yoriko Heianza  1 , Tao Zhou  1 , Dianjianyi Sun  1 , Frank B Hu  2   3 , JoAnn E Manson  3   4 , Lu Qi  1   2
Affiliations

Genetic susceptibility, plant-based dietary patterns, and risk of cardiovascular disease

Yoriko Heianza et al. Am J Clin Nutr. .

Abstract

Background: Plant-based dietary patterns may be related to better cardiovascular profiles. Whether a healthy plant-based dietary index is predictive of future cardiovascular disease (CVD) across people with different genetic susceptibility remains uncertain.

Objective: We investigated associations of adherence to healthy plant-based diets with the incidence of CVD considering the genetic susceptibility.

Methods: This prospective cohort study included a total of 156,148 adults initially free of CVD and cancer. We calculated a healthful plant-based diet index (healthful-PDI) in which healthy plant foods received positive scores, and less healthy plant foods and animal foods received reverse scores. Genetic risk scores (GRSs) for myocardial infarction (MI) and stroke were calculated to assess interactions between healthful-PDI and GRSs.

Results: During 5 y of follow-up, we observed 1812 incident cases of CVD. Higher healthful-PDI was associated with a lower CVD risk [HR per 10-unit increment: 0.87 (95% CI: 0.81, 0.93) after adjusting for demographic, lifestyle, and other dietary factors (model 1); HR 0.90 (0.84, 0.97) after further adjusting for obesity and metabolic factors (model 2)]. The risk of CVD was gradually decreased in association with higher adherence to healthful-PDI, regardless of genetic susceptibility. The inverse associations of healthful-PDI with CVD were consistently observed in people with low GRS-MI [HR 0.85 (95% CI: 0.76, 0.94) in model 1; HR 0.88 (0.79, 0.97) in model 2] and those with high GRS-MI [HR 0.91 (0.82, 0.99) in model 1; HR 0.94 (0.86, 1.04) in model 2], without significant interactions (Pinteraction = 0.59 in model 1; Pinteraction = 0.66 in model 2). Similarly, higher healthful-PDI was related to a lower risk of CVD, regardless of low/high GRS-stroke.

Conclusion: Adherence to healthy plant-based diets may be associated with a decreased incidence of CVD in the entire population, suggesting that plant-based dietary patterns may modify the risk of CVD, regardless of genetic susceptibility.

Keywords: cardiovascular risk; genetic risk; myocardial infarction; plant-based dietary index; plant-based nutrition; prospective study; stroke.

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Figures

FIGURE 1
FIGURE 1
Cumulative incidence of cardiovascular disease according to quintile categories of healthful plant-based diet index. Kaplan–Meier analysis was performed to show the cumulative incidence rate across the quintiles of healthful-PDI in total participants (n = 156,148). CVD, cardiovascular disease; GRS, genetic risk score; PDI, plant-based diet index; Q, quintile.
FIGURE 2
FIGURE 2
Risk of cardiovascular disease by healthful-plant-based diet index. Spline regression was performed with 5 knots, and the lowest value of healthful-PDI (a score of 40) was used as a reference value with the highest 1% or lowest 1% of healthful-PDI scores excluded in the analysis to minimize the potential impact of outliers (total n = 153,428 including 1770 events; score ranges in the spline analysis: 40–72). HR (95% CI) after controlling for age, sex, ethnicity, education, parental history of heart disease, smoking habit, physical activity, multivitamin use, total energy intake, alcohol consumption, Townsend Deprivation Index, BMI, hypertension, dyslipidemia, and type 2 diabetes. CVD, cardiovascular disease; PDI, plant-based diet index.
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