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Quality of plant-based diets in relation to 10-year cardiovascular disease risk: the ATTICA cohort study

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Abstract

Purpose

We prospectively evaluated the association between quality of plant-based diets and 10-year first fatal/non-fatal cardiovascular disease (CVD) incidence.

Methods

ATTICA study was conducted in the greater metropolitan Athens area, Greece, during 2001–2002 studying men and women (aged > 18 years old) free of CVD at baseline. Follow-up CVD assessment (2011–2012) was achieved in n = 2,020 participants (n = 317 cases). Dietary assessment was based on a validated semi-quantitative paper-based food frequency questionnaire. Overall, healthful, and unhealthful plant-based dietary indices (PDI, hPDI and uPDI) were calculated through a standard published procedure. The association between plant-based indices and CVD outcome has been evaluated via Cox regression analysis.

Results

The CVD event rate was 15.7% (n = 317) with a median follow-up time of 8.41 years. The highest (3rd PDI tertile) vs. lowest (1st tertile) adherence to plant-based pattern—irrespective to healthfulness of food products consumed—was inversely associated with CVD (hazard ratio (HR) 0.56; 95% confidence interval (95% CI) 0.14, 2.25) yet the CI was wide. Ranking from 1st to 2nd and 3rd hPDI tertile the CVD event rate was 6.4%, 10.5% and 16.2%, respectively (p = 0.003). Multi-variable adjusted analysis revealed that participants assigned in 2nd and 3rd hPDI tertile had 47% (HR 0.53; 95% CI 0.25–1.08) and 68% (HR 0.32; 95% CI 0.16–0.63) lower risk to develop CVD compared with their 1st tertile counterparts. Conversely, a positive association between uPDI and CVD risk was revealed in dose–response analysis (HR(per 5 units increase in uPDI) 1.34; 95% CI 0.95–2.37)).

Conclusions

Quality of plant-based diets is important and needs to be considered, as not all plant-source foods have beneficial cardiovascular effects.

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Data and material availability

Data are not available for confidentiality reasons.

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Acknowledgements

Authors would like to thank the ATTICA study investigators.

Funding

The ATTICA study is supported by research Grants from the Hellenic Cardiology Society [HCS2002] and the Hellenic Atherosclerosis Society [HAS2003]. CSM has been a shareholder of and reports Grants through his institution and personal consulting fees from Coherus Inc, he reports grants through his institution and personal consulting fees from Esai and Novo Nordisk, reports personal consulting fees and in kind support with research reagents from Ansh inc, reports personal consulting fees from Genfit, P.E.S., Intercept, Astra Zeneca, Aegerion and Regeneron, reports in kind support (educational activity meals at and through his institution) from Amarin, Jansen, Boehringer Ingelheim and travel support and fees from TMIOA, the California Walnut Commission, College Internationale Researche Servier and the Cardio Metabolic Health Conference.

Author information

Authors and Affiliations

  1. Biostatistics, Research Methods and Nutrition Epidemiology, School Of Health Science and Education, Department of Nutrition and Dietetics, Harokopio University, Athens, Greece

    Matina Kouvari, Thomas Tsiampalis, Ekavi Georgousopoulou & Demosthenes B. Panagiotakos

  2. Faculty of Health, University of Canberra, Canberra, Australia

    Matina Kouvari & Demosthenes B. Panagiotakos

  3. First Cardiology Clinic, School of Medicine, University of Athens, Athens, Greece

    Christina Chrysohoou, John Skoumas & Christos S. Pitsavos

  4. School of Medicine, The University of Notre Dame, Sydney, Australia

    Ekavi Georgousopoulou

  5. Medical School, Australian National University, Canberra, Australia

    Ekavi Georgousopoulou

  6. Department of Medicine, Boston VA Healthcare System and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02215, USA

    Christos S. Mantzoros

Authors
  1. Matina Kouvari
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  2. Thomas Tsiampalis
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  3. Christina Chrysohoou
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  4. Ekavi Georgousopoulou
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  5. John Skoumas
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  6. Christos S. Mantzoros
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  7. Christos S. Pitsavos
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  8. Demosthenes B. Panagiotakos
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Contributions

MK wrote the manuscript (interpretation of results and discussion). TT performed the statistical analysis. DBP conceived and designed the analysis, generated the primary research hypothesis, provided input in terms of statistical analysis and critically reviewed the manuscript. CSM provided input in terms of the analysis and critically reviewed the manuscript. JS and CP were responsible for the study design and implementation while they critically reviewed the manuscript. EG was involved in the 10-year follow-up of study and critically reviewed the manuscript. CC was involved in the baseline and follow-up measurement and critically reviewed the manuscript.

Corresponding author

Correspondence to Demosthenes B. Panagiotakos.

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Conflict of interest

The rest of the authors declare no conflicts of interest.

Ethics approval

ATTICA study was approved by the Bioethics Committee of Athens Medical School. The study was carried out in accordance with the Declaration of Helsinki (1989) of the World Medical Association.

Consent to participate

All participants were informed about the study aims and procedures and provided written informed consent.

Consent for publication

All authors have read and approved submission of the manuscript.

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Kouvari, M., Tsiampalis, T., Chrysohoou, C. et al. Quality of plant-based diets in relation to 10-year cardiovascular disease risk: the ATTICA cohort study. Eur J Nutr 61, 2639–2649 (2022). https://doi.org/10.1007/s00394-022-02831-0

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  • DOI: https://doi.org/10.1007/s00394-022-02831-0

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