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Vegetarian and vegan diets and the risk of cardiovascular disease, ischemic heart disease and stroke: a systematic review and meta-analysis of prospective cohort studies

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Dybvik, Jarle Sæby, Svendsen, Mette, Aune, Dagfinn·2023·European Journal of Nutrition
DOI 10.1007/s00394-022-02942-8PMC PMC9899747
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Abstract

Purpose: Vegetarian diets have been associated with reduced risk of ischemic heart disease (IHD). However, results regarding cardiovascular disease (CVD) overall and stroke are less clear. We conducted a systematic review and meta-analysis of prospective cohort studies on CVD, IHD and stroke risk among vegetarians or vegans versus nonvegetarians to clarify these associations. Methods: PubMed and Ovid Embase databases were searched through August 12, 2021. Prospective cohort studies reporting adjusted relative risk (RR) estimates and 95% confidence intervals (CIs) for incidence or mortality from CVD, IHD and stroke, comparing vegetarians and vegans to nonvegetarians were included. Risk of bias (RoB) was assessed using ROBINS-I and the strength of evidence was assessed using World Cancer Research Fund (WCRF) criteria. Summary RRs (95% CIs) were estimated using a random effects model. Results: Thirteen cohort studies (844,175 participants, 115,392 CVD, 30,377 IHD, and 14,419 stroke cases) were included. The summary RR for vegetarians vs. nonvegetarians was 0.85 (95% CI: 0.79–0.92, I2 = 68%, n = 8) for CVD, 0.79 (95% CI: 0.71–0.88, I2 = 67%, n = 8) for IHD, 0.90 (95% CI: 0.77–1.05, I2 = 61%, n = 12) for total stroke, and for vegans vs. nonvegetarians was 0.82 (95% CI: 0.68–1.00, I2 = 0%, n = 6) for IHD. RoB was moderate (n = 8) to serious (n = 5). The associations between vegetarian diets and CVD and IHD were considered probably causal using WCRF criteria. Conclusions: Vegetarian diets are associated with reduced risk of CVD and IHD, but not stroke, but further studies are needed on stroke. These findings should be considered in dietary guidelines. Review registration: No review protocol registered.

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  • Abundant evidence from observational and intervention studies indicates that vegan diets are associated with improved cardiovascular health and decreased risk of cardiovascular disease.

    “Abundant evidence from observational and intervention studies7,8,9,10,11,12,13 indicates that vegan diets are associated with improved cardiovascular health and decreased risk of cardiovascular disease, likely because of the higher daily consumption of vegetables and fruits, legumes, whole grains and nuts, and seeds compared with other different types of dietary patterns.14”

    From Cardiometabolic Effects of Omnivorous vs Vegan Diets in Identical Twins: A Randomized Clinical Trial (2023) · cites this paper as [8]

    The Results (Cardiovascular disease) found no clear association between vegan diets and CVD risk. The Results (Grading of evidence) also describe the evidence for vegans as limited, rather than abundant; the intervention evidence cited there concerns vegetarian diets, not specifically vegan diets. (LLM, conf=0.89)

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Cited by

Sorted by citations

Authors
Dybvik, J. S., Svendsen, M., & Aune, D.
Affiliations
  • University of Oslo (NO)
  • Oslo University Hospital (NO)
Corresponding author
Dybvik, Jarle Sæby
ORCID
Venue
European Journal of Nutrition
Publisher
Springer Science and Business Media LLC
Published
2022-08-27
Volume
62
Issue
1
Pages
51-69
ISSN
  • 1436-6207 (ISSN-L)
  • 1436-6215
DOI
10.1007/s00394-022-02942-8
PMC
PMC9899747
OpenAlex
W4293340344
Cited by
150
References
15
Citations by year
2026: 37 · 2025: 38 · 2024: 48 · 2023: 26 · 2022: 1
FWCI
5.62
Type
journal article
Language
en
Open access
Licence
Locations
  • European Journal of Nutrition (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Duo Research Archive (University of Oslo) (submittedVersion)
  • Spiral (Imperial College London) (submittedVersion, cc-by)
  • NORA - Norwegian Open Research Archives (submittedVersion, cc-by)
Funders
  • Helse Sør-Øst RHF (2017076)
  • University of Oslo
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
  • Physical Sciences › Environmental Science › Ecology › Agriculture Sustainability and Environmental Impact
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
Keywords
vegetarian diet, vegan diet, cardiovascular disease, ischemic heart disease, stroke, dietary habits, cardiovascular risk, dietary guidelines
MeSH terms
Vegetarians, Diet, Vegan, Cardiovascular Diseases, Humans, Prospective Studies, Diet, Vegetarian, Cohort Studies, Myocardial Ischemia

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