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Risk of Cardiovascular Disease Incidence and Mortality in Vegetarians and Eaters of Fish, Poultry, and Meat
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Analysis of data from the UK Biobank showed that the risks of incident cardiovascular disease (CVD), ischemic heart disease, myocardial infarction, stroke, and heart failure over 8.5 years were lower in fish-eaters compared with meat-eaters. The risk of adverse outcomes was similar in individuals who ate meat and those who ate fish and poultry.
- The risk of adverse CV outcomes was lower in fish-eaters compared with those who ate meat and poultry.
abstract
This abstract is available on the publisher's site.
Access this abstract nowAIMS
To compare the incidence and mortality risk for cardiovascular diseases (CVD) [CVD and also ischaemic heart disease (IHD), myocardial infarction (MI), stroke, and heart failure (HF)] among people with different types of diets-including vegetarians, fish eaters, fish and poultry eaters, and meat-eaters-using data from UK Biobank.
METHODS AND RESULTS
A total of 422 791 participants (55.4% women) were included in this prospective analysis. Using data from a food frequency questionnaire, four types of diets were derived. Associations between types of diets and health outcomes were investigated using Cox proportional hazard models. Meat-eaters comprised 94.7% of the cohort and were more likely to be obese than other diet groups. After a median follow-up of 8.5 years, fish eaters, compared with meat-eaters, had lower risks of incident CVD {hazard ratios (HR): 0.93 [95% confidence intervals (CI): 0.88-0.97]}, IHD [HR: 0.79 (95% CI: 0.70-0.88)], MI [HR: 0.70 (95% CI: 0.56-0.88)], stroke [HR: 0.79 (95% CI: 0.63-0.98)] and HF [HR: 0.78 (95% CI: 0.63-0.97)], after adjusting for confounders. Vegetarians had lower risk of CVD incidence [HR: 0.91 (95% CI: 0.86-0.96)] relative to meat-eaters. In contrast, the risk of adverse outcomes was not different in fish and poultry eaters compared with meat-eaters. No associations were identified between types of diets and CVD mortality.
CONCLUSION
Eating fish rather than meat or poultry was associated with a lower risk of a range of adverse cardiovascular outcomes. Vegetarianism was only associated with a lower risk of CVD incidence.
Additional Info
Disclosure statements are available on the authors' profiles:
Vegetarians, Fish, Poultry, and Meat-Eaters: Who Has Higher Risk of Cardiovascular Disease Incidence and Mortality? A Prospective Study From UK Biobank
Eur Heart J 2020 Dec 14;[EPub Ahead of Print], F Petermann-Rocha, S Parra-Soto, S Gray, J Anderson, P Welsh, J Gill, N Sattar, FK Ho, C Celis-Morales, JP PellFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Primary Care
Pesco-Vegetarian Wins Again
A number of studies have supported the simple graphic below. One of the key factors appears to be the diet’s influence on inflammation. The Women’s Health Study found that those who had the highest Mediterranean diet score compared with the lowest had a 28% lower risk of cardiovascular events.1 And when the EVADE CAD study compared the risk factors associated with heart disease of a vegetarian diet versus the AHA diet, inflammation (hs-CRP) was found to be the greatest risk factor most commonly associated with red meat.2 And, when three large cohorts were combined, the Nurses’ Health Study I and II and the Health Professionals Follow-Up Study, a comparison between a pro-inflammatory diet (red and processed meats with refined carbohydrates) and an anti-inflammatory diet (vegetables, whole grains, and fruits) found the risk of coronary artery disease was increased by 46% in individuals adhering to the pro-inflammatory diet (HR, 1.46).3
In a recent summary of the evidence published in JACC,4 adding fish and fasting to a high-fiber, plant-based diet may provide the most powerful polymeal possible in the fight against heart disease, putting any polypill to shame. The findings of the Adventist Study also supported less heart disease in those with a pesco-vegetarian eating pattern, with a 46% reduction in colon cancer as an added benefit.5
Now you can add data from the UK Biobank to this long list. The 422,791 participants were divided into different eating pattern categories, which included meat eaters, vegetarians, fish eaters, and combined fish and poultry eaters, from food questionnaires. The table below shows the results after 8.5 years when confounders were controlled.
Eating Pattern
Hazard Ratio
Myocardial Infarction
Meat Eaters6
1.0
Vegetarians
0.79
Fish Eaters
0.7
Fish & Poultry Eaters
0.88
Heart Failure
Meat Eaters6
1.0
Vegetarians
0.99
Fish Eaters
0.78
Fish & Poultry Eaters
0.94
Stroke
Meat Eaters6
1.0
Vegetarians
0.84
Fish Eaters
0.79
Fish & Poultry Eaters
0.81
Frankly, reviewing this nutritional evidence is getting a little boring. Now we need to apply it so it can be translated into healthier outcomes.
References