Relationship Between a Plant-Based Portfolio Diet and Risk of CVD
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Using data from the Women's Health Initiative from 1993 to 2017, the authors show a reduction in cardiovascular (CV) events (overall CV events, coronary heart disease, heart failure) in those women who adhered to a plant-based Portfolio diet (plant proteins, nuts, viscous fiber, phytosterols, and mono-unsaturated fats).
- In this prospective study including postmenopausal women, adherence to a Portfolio diet was associated with a reduced risk of total CVD, coronary heart disease, and heart failure. No relationship between a Portfolio diet and later stroke or atrial fibrillation events was observed.
abstract
This abstract is available on the publisher's site.
Access this abstract nowBackground
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.
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Additional Info
Disclosure statements are available on the authors' profiles:
Relationship Between a Plant-Based Dietary Portfolio and Risk of Cardiovascular Disease: Findings From the Women's Health Initiative Prospective Cohort Study
J Am Heart Assoc 2021 Aug 04;[EPub Ahead of Print], AJ Glenn, K Lo, DJA Jenkins, BA Boucher, AJ Hanley, CWC Kendall, JE Manson, MZ Vitolins, LG Snetselaar, S Liu, JL SievenpiperFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
The Portfolio Diet: Numbers and Outcomes
It has been almost 20 years since the first study was published showing that a Portfolio diet was equal to 20 mg of lovastatin in lowering LDL cholesterol by 28% to 30%.1 Fast forward to 2021 and we now have evidence showing a reduction in CV risk.
The cohort studied was 50- to 79-year-old postmenopausal women from the Women’s Health Initiative. They were followed for 15.3 years. A food frequency questionnaire was used to assess the Portfolio diet. Comparing those in the highest quartile versus of adherence to the diet the lowest found the following.
Risk of heart failure
HR = 0.83 (↓17%)
Risk of coronary heart disease
HR = 0.86 (↓14%)
Risk of total cardiovascular disease
HR =0.89 (↓11%)
Summary of the Portfolio Diet
Components
Foods included in the WHI Survey
Specific Doses to Lower LDL1
Plant protein
Beans, soy (tofu or soy nuts), green peas; textured vegetable products; bean soups
50 g of soy protein. 10 g of soy can be obtained from 1 to 2 cups of soy milk, 4 oz of tofu, 2 oz of soy flour, or 1/2 cup of textured soy protein
Viscous fiber
Oranges, grapefruit and tangerines; apples and pears; strawberries; okra; oats
20 g of viscous fiber from foods such as oats, barley, psyllium (eg, 3–4 tbsp of psyllium)
Nuts
Peanut butter, peanuts, other nuts and seeds
30 g of almonds—about 23 almonds (1 oz)
Phytosterols
Estimated from all plant foods
2 g (.064 oz) of plant sterols from spreads such as Benecol® or Take Control® spreads (1 tbsp = 1 g)
MUFA
Olive or canola oil; avocado and guacamole
Not included in original study
Saturated fat (low is better)
High-fat dairy; eggs; chicken/turkey with skin; red and processed meats; organ meats; gravy; butter
Not included in original study
WHI = Women’s Health Initiative; MUFA = monounsaturated fatty acids
Phytosterols (phyto = plant) are steroids that only plants can make. Humans don’t make them; but, when they are eaten, cholesterol absorption in inhibited. Most any plant will be rich in plant sterols. A handout that summarizes the Portfolio diet and other nonpharmaceutical strategies to lower cholesterol can be found here.
Research studies showing improvement in numbers without a pragmatic reduction in disease events are left wanting. We now have data showing improvement in both.
Let food be thy medicine
Reference