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Title: Relationship between a plant-based dietary portfolio and risk of cardiovascular disease : findings from the women’s health initiative prospective cohort study
Authors: Glenn, AJ
Lo, K 
Jenkins, DJA
Boucher, BA
Hanley, AJ
Kendall, CWC
Manson, JE
Vitolins, MZ
Snetselaar, LG
Liu, S
Sievenpiper, JL
Issue Date: Aug-2021
Source: Journal of the American Heart Association, 17 Aug. 2021, v. 10, no. 16, e021515
Abstract: BACKGROUND: 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.
Keywords: Cardiovascular disease
Dietary patterns
Dietary portfolio
Plant-based
Prospective cohort study
Publisher: Wiley Blackwell
Journal: Journal of the American Heart Association 
ISSN: 2047-9980
DOI: 10.1161/JAHA.121.021515
Rights: © 2021 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley. This is an open access article under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
The following publication Glenn, A. J., Lo, K., Jenkins, D. J., Boucher, B. A., Hanley, A. J., Kendall, C. W., ... & Sievenpiper, J. L. (2021). Relationship Between a Plant‐Based Dietary Portfolio and Risk of Cardiovascular Disease: Findings From the Women's Health Initiative Prospective Cohort Study. Journal of the American Heart Association, 10(16), e021515 is available at https://doi.org/10.1161/JAHA.121.021515
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