Association between Plant-Based Dietary Patterns and Risk of Cardiovascular Disease: A Systematic Review and Meta-Analysis of Prospective Cohort Studies

Plant-based diets, characterized by a higher consumption of plant foods and a lower consumption of animal foods, are associated with a favorable cardiovascular disease (CVD) risk, but evidence regarding the association between plant-based diets and CVD (including coronary heart disease (CHD) and stroke) incidence remain inconclusive. A literature search was conducted using the PubMed, EMBASE and Web of Science databases through December 2020 to identify prospective observational studies that examined the associations between plant-based diets and CVD incidence among adults. A systematic review and a meta-analysis using random effects models and dose–response analyses were performed. Ten studies describing nine unique cohorts were identified with a total of 698,707 participants (including 137,968 CVD, 41,162 CHD and 13,370 stroke events). Compared with the lowest adherence, the highest adherence to plant-based diets was associated with a lower risk of CVD (RR 0.84; 95% CI 0.79–0.89) and CHD (RR 0.88; 95% CI 0.81–0.94), but not of stroke (RR 0.87; 95% CI 0.73–1.03). Higher overall plant-based diet index (PDI) and healthful PDI scores were associated with a reduced CVD risk. These results support the claim that diets lower in animal foods and unhealthy plant foods, and higher in healthy plant foods are beneficial for CVD prevention. Protocol was published in PROSPERO (No. CRD42021223188).

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Genetic susceptibility, plant-based dietary patterns, and risk of cardiovascular disease

American Journal of Clinical Nutrition ◽

10.1093/ajcn/nqaa107 ◽

2020 ◽

Vol 112 (1) ◽

pp. 220-228 ◽

Cited By ~ 1

Author(s):

Yoriko Heianza ◽

Tao Zhou ◽

Dianjianyi Sun ◽

Frank B Hu ◽

JoAnn E Manson ◽

...

Keyword(s):

Cardiovascular Disease ◽

Genetic Susceptibility ◽

Dietary Patterns ◽

Dietary Factors ◽

Risk Scores ◽

Healthy Plant ◽

Cvd Risk ◽

Plant Foods ◽

Dietary Index ◽

Incident Cases

ABSTRACT Background Plant-based dietary patterns may be related to better cardiovascular profiles. Whether a healthy plant-based dietary index is predictive of future cardiovascular disease (CVD) across people with different genetic susceptibility remains uncertain. Objective We investigated associations of adherence to healthy plant-based diets with the incidence of CVD considering the genetic susceptibility. Methods This prospective cohort study included a total of 156,148 adults initially free of CVD and cancer. We calculated a healthful plant-based diet index (healthful-PDI) in which healthy plant foods received positive scores, and less healthy plant foods and animal foods received reverse scores. Genetic risk scores (GRSs) for myocardial infarction (MI) and stroke were calculated to assess interactions between healthful-PDI and GRSs. Results During 5 y of follow-up, we observed 1812 incident cases of CVD. Higher healthful-PDI was associated with a lower CVD risk [HR per 10-unit increment: 0.87 (95% CI: 0.81, 0.93) after adjusting for demographic, lifestyle, and other dietary factors (model 1); HR 0.90 (0.84, 0.97) after further adjusting for obesity and metabolic factors (model 2)]. The risk of CVD was gradually decreased in association with higher adherence to healthful-PDI, regardless of genetic susceptibility. The inverse associations of healthful-PDI with CVD were consistently observed in people with low GRS-MI [HR 0.85 (95% CI: 0.76, 0.94) in model 1; HR 0.88 (0.79, 0.97) in model 2] and those with high GRS-MI [HR 0.91 (0.82, 0.99) in model 1; HR 0.94 (0.86, 1.04) in model 2], without significant interactions (Pinteraction = 0.59 in model 1; Pinteraction = 0.66 in model 2). Similarly, higher healthful-PDI was related to a lower risk of CVD, regardless of low/high GRS-stroke. Conclusion Adherence to healthy plant-based diets may be associated with a decreased incidence of CVD in the entire population, suggesting that plant-based dietary patterns may modify the risk of CVD, regardless of genetic susceptibility.

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Association between berries intake and cardiovascular diseases risk factors: a systematic review with meta-analysis and trial sequential analysis of randomized controlled trials

Food & Function ◽

10.1039/c7fo01551h ◽

2018 ◽

Vol 9 (2) ◽

pp. 740-757 ◽

Cited By ~ 19

Author(s):

Ângelo Luís ◽

Fernanda Domingues ◽

Luísa Pereira

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Cardiovascular Disease ◽

Sequential Analysis ◽

Meta Analysis ◽

Trial Sequential Analysis ◽

Controlled Trials ◽

Cvd Risk Factors ◽

Cvd Risk ◽

Randomized Controlled

The main goal of this work was to clarify the effects of the consumption of berries on cardiovascular disease (CVD) risk factors by performing a systematic review followed by a meta-analysis and a trial sequential analysis (TSA).

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Incidence and prevalence of systemic sclerosis globally: a comprehensive systematic review and meta-analysis

Rheumatology ◽

10.1093/rheumatology/keab190 ◽

2021 ◽

Author(s):

Majd Bairkdar ◽

Marios Rossides ◽

Helga Westerlind ◽

Roger Hesselstrand ◽

Elizabeth V Arkema ◽

...

Keyword(s):

Systematic Review ◽

Web Of Science ◽

Meta Analysis ◽

Case Definition ◽

Random Effects Models ◽

Pooled Prevalence ◽

Prisma Statement ◽

The World ◽

Large Heterogeneity ◽

Meta Analyses

Abstract Objectives We aimed to conduct a systematic review and meta-analysis on the incidence and prevalence of SSc covering the entire literature. Methods This study followed the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement of 2009. We conducted a systematic search in MEDLINE, Web of Science and Embase to identify articles reporting incidence and/or prevalence of SSc. Two authors conducted the search, reviewed articles for inclusion and extracted relevant data. We used random-effects models to estimate the pooled prevalence and incidence of SSc and performed subgroup analyses by sex, case definition and region to investigate heterogeneity. We explored the association between calendar period and reported estimates using meta-regression. Results Among 6983 unique records identified, we included 61 studies of prevalence and 39 studies of incidence in the systematic review. The overall pooled prevalence of SSc was 17.6 (95% CI 15.1, 20.5) per 100 000 and the overall pooled incidence rate of SSc was 1.4 (95% CI 1.1, 1.9) per 100 000 person-years. We observed significant regional variations in reported estimates; studies conducted in North America reported considerably higher estimates than other regions. The pooled incidence and prevalence in women were five times higher than in men. More recent studies reported higher estimates than older ones. Conclusion In this comprehensive review of the incidence and prevalence of SSc across the world, there was large heterogeneity among estimates, which should be taken into consideration when interpreting the results.

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Assessment of the association of plant-based diets with cardiovascular disease risk profile in Africa: a systematic review and meta-analysis protocol

BMJ Open ◽

10.1136/bmjopen-2020-036792 ◽

2020 ◽

Vol 10 (6) ◽

pp. e036792 ◽

Cited By ~ 1

Author(s):

Tatum Lopes ◽

Annalise E. Zemlin ◽

Rajiv T. Erasmus ◽

Mieke Faber ◽

Andre P. Kengne

Keyword(s):

Systematic Review ◽

Cardiovascular Disease ◽

Cause Of Death ◽

Full Text ◽

Meta Analysis ◽

Risk Profile ◽

Sensitivity Analyses ◽

Cardiometabolic Health ◽

Cvd Risk ◽

African Populations

IntroductionCardiovascular disease (CVD) is currently the leading cause of death worldwide. In Africa where infectious diseases are still the leading cause of death, the contribution of non-communicable diseases led by CVDs has significantly increased in recent years. The rise of CVDs in Africa is attributed at least in part to the adoption of sedentary behaviours and unhealthy eating habits, which are linked with urbanisation and westernisation of cultures. Dietary attributes associated with CVD risk have been less investigated in Africa. However, evidence from developed nations has reported a protective effect of healthy dietary patterns such as plant-based diets (PBDs) on cardiometabolic health. The current protocol is for a review aiming to assess existing evidence on the association of PBDs with CVD risk profile in African populations.Methods and analysisThis protocol was developed following the 2015 guidelines of the Preferred Reporting Items for Systematic Review and Meta-analysis Protocols. We will conduct a comprehensive search of the literature for published studies on PBDs in relation to CVD risk profile in African populations. Observational studies published between January 1990 and December 2019 will be screened. A search strategy using keywords and medical subject headings terms will be applied across multiple scientific databases including PubMed-Medline, Scopus and EBSCOhost and the African Journals Online platform. Manual searches of reference lists from relevant articles will be performed. Citations will be traced using the ISI Web of Science to further identify eligible studies. Grey literature will also be screened for relevant abstracts from conference proceedings, and experts in the field will be contacted where appropriate. Two investigators will independently screen all the titles and abstracts to determine which records are eligible for full-text review. Subsequently, two investigators will review the eligible full text using the selection criteria. A third investigator will be consulted to resolve any discrepancies. Data will be extracted from studies that are eligible for the review. Meta-analysis will be performed for studies with similar or comparable methods and reported outcome measures. This will be performed overall, and by major study-level characteristics. Heterogeneity in the estimates across studies will be assessed and quantified with the use of Cochrane Q and I2 statistics, respectively. Publication biases will be investigated through funnel plots and Egger test of bias. Relevant sensitivity analyses will be performed to confirm the robustness of the findings.Ethics and disseminationThe review will analyse data from published studies; therefore, it does not require ethical approval. The findings of the review will be submitted as part of a PhD thesis at Stellenbosch University, South Africa. Additionally, the findings will be presented at conferences and published in a peer-reviewed journal.PROSPERO registration numberCRD42020159862.

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eHealth interventions for reducing cardiovascular disease risk in men: a systematic review and meta-analysis

European Journal of Cardiovascular Nursing ◽

10.1093/eurjcn/zvab060.059 ◽

2021 ◽

Vol 20 (Supplement_1) ◽

Author(s):

J Mcmahon ◽

DR Thompson ◽

MC Pascoe ◽

K Brazil ◽

CF Ski

Keyword(s):

Systematic Review ◽

Cardiovascular Disease ◽

Behavior Change ◽

Systematic Reviews ◽

Meta Analysis ◽

Database Search ◽

Controlled Trials ◽

Cochrane Central Register ◽

Cvd Risk ◽

Meta Analyses

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Department for the Economy (DfE) studentships Background. Men remain at a higher risk of developing cardiovascular disease (CVD) than women and behavioral risk factor modification is an important preventive measure. However, engaging men in behavior change interventions is challenging. eHealth interventions have the potential to address this gap, though their effectiveness for reducing CVD risk in men is unclear. Purpose. To conduct a systematic review and meta-analysis to evaluate the effectiveness of eHealth interventions for reducing CVD risk in men. Methods. This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and principles laid out by the Cochrane Handbook for Systematic Reviews of Interventions. A search of published randomised controlled trials (RCTs) with no date restrictions up to July 2020 was conducted across five electronic databases: Cochrane Central register of Controlled Trials (CENTRAL), Medline, CINAHL Plus, PsycINFO and SCOPUS. Reference lists of relevant systematic reviews and meta-analyses were manually searched for additional trials not identified during the database search. Eligible studies were RCTs that focused on the use of eHealth to improve a minimum of two major CVD related risk factors in males aged 18 years or older. Results. A total of 3168 records were retrieved from the online database search, with nine trials meeting the inclusion criteria following screening and full-text assessment. Study quality ranged from low to unclear, with one trial at a high risk of bias. Compared to those in a control group or receiving printed materials, participants randomised to an eHealth intervention had statistically significant improvements in BMI (Z=-2.75, p = 0.01), body weight (Z=-3.25, p = 0.01), waist circumference (Z=-2.30, p = 0.02) and systolic (Z=-3.57, p = 0.01) and diastolic (Z=-3.56, p = 0.01) blood pressure. Though less evident, there were also improvements in physical activity and diet in favour of the intervention group. Conclusion. This was the first systematic review and meta-analysis conducted on the effectiveness of eHealth interventions for reducing CVD risk in men. This review suggests that eHealth interventions can reduce CVD risk in adult men through behavior change. However, we were unable to determine the association between intervention characteristics and outcomes. Also, overall, participant adherence to the intervention was poor. Both of these issues should be considered in future studies.

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Nut consumption and incidence of cardiovascular diseases and cardiovascular disease mortality: a meta-analysis of prospective cohort studies

Nutrition Reviews ◽

10.1093/nutrit/nuz042 ◽

2019 ◽

Vol 77 (10) ◽

pp. 691-709 ◽

Cited By ~ 18

Author(s):

Nerea Becerra-Tomás ◽

Indira Paz-Graniel ◽

Cyril W.C. Kendall ◽

Hana Kahleova ◽

Dario Rahelić ◽

...

Keyword(s):

Systematic Review ◽

Cardiovascular Disease ◽

Prospective Studies ◽

Data Extraction ◽

Meta Analysis ◽

Nutrition Therapy ◽

Grade System ◽

Pool Data ◽

Inverse Association ◽

Stroke Incidence

Abstract Context Previous meta-analyses evaluating the association between nut consumption and the risk of cardiovascular disease (CVD) had substantial methodological limitations and lacked recently published large prospective studies; hence, making an updated meta-analysis highly desirable. Objective To update the clinical guidelines for nutrition therapy in relation to the European Association for the Study of Diabetes (EASD), a systematic review and meta-analysis of prospective studies was conducted using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system to summarize the evidence of the association between total nuts, specific types of nuts, and the incidence of, and mortality from, CVD outcomes. Data sources Relevant articles were identified by searching the PubMed and Cochrane databases. Data extraction Two independent researchers screened the articles to identify those that met the inclusion criteria. Data analysis The inverse variance method with fixed-effect or random-effects models was used to pool data across studies (expressed as risk ratio [RR] and 95% confidence interval [CI]). Heterogeneity was tested and quantified using the Cochrane Q test and I2-statistic, respectively. The GRADE system was used to assess the quality of the evidence. Results Nineteen studies were included in the analyses. The results revealed an inverse association between total nut consumption (comparing highest vs lowest categories) and CVD incidence (RR, 0.85; 95%CI, 0.800.91; I2, 0%), CVD mortality (RR, 0.77; 95%CI, 0.72–0.82; I2, 3%), coronary heart disease (CHD) incidence (RR, 0.82; 95%CI, 0.69–0.96; I2, 74%), CHD mortality (RR, 0.76; 95%CI, 0.67–0.86; I2, 46%), stroke mortality (RR, 0.83; 95%CI, 0.75–0.93; I2, 0%), and atrial fibrillation (RR, 0.85; 95%CI, 0.73–0.99; I2, 0%). No association was observed with stroke incidence and heart failure. The certainty of the evidence ranged from moderate to very low. Conclusions This systematic review and meta-analysis revealed a beneficial role of nut consumption in reducing the incidence of, and mortality from, different CVD outcomes.

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Legume consumption and CVD risk: a systematic review and meta-analysis

Public Health Nutrition ◽

10.1017/s1368980016002299 ◽

2016 ◽

Vol 20 (2) ◽

pp. 245-254 ◽

Cited By ~ 51

Author(s):

Stefano Marventano ◽

Maria Izquierdo Pulido ◽

Claudia Sánchez-González ◽

Justyna Godos ◽

Attilio Speciani ◽

...

Keyword(s):

Systematic Review ◽

Lower Risk ◽

Stroke Risk ◽

Meta Analysis ◽

Confounding Factors ◽

Cvd Risk ◽

Random Effects Models ◽

Reference Category ◽

Null Results ◽

Prospective Cohort Studies

AbstractObjectiveThe aim of the present study was to systematically review and perform a meta-analysis of prospective cohort studies exploring the association between dietary legume consumption and CVD risk, including CHD and stroke.DesignThe PubMed and EMBASE databases were searched up to December 2015. A meta-analysis of the highestv.lowest (reference) category of dietary legume consumption was performed through random-effects models.ResultsFourteen studies conducted on eleven cohorts and accounting for a total of 367 000 individuals and 18 475 cases of CVD (7451 CHD and 6336 stroke cases) were considered for the analyses. Compared with lower legume consumption, the highest category of exposure was associated with a decreased risk of 10 % in both CVD and CHD (relative risk=0·90; 95 % CI 0·84, 0·97) with no or little evidence of heterogeneity and no publication bias. Null results were found regarding legume consumption and stroke risk. No substantial confounding factors were evident in stratified analyses.ConclusionsLegume consumption was associated with lower risk of CVD. Legumes’ intrinsic characteristics, because they are often part of an overall healthy diet, or because they are a substitute for unhealthy sources of protein may potentially explain the current findings.

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Neutrophil Lymphocyte Ratio and Cardiovascular Disease Risk: A Systematic Review and Meta-Analysis

BioMed Research International ◽

10.1155/2018/2703518 ◽

2018 ◽

Vol 2018 ◽

pp. 1-11 ◽

Cited By ~ 36

Author(s):

Teeranan Angkananard ◽

Thunyarat Anothaisintawee ◽

Mark McEvoy ◽

John Attia ◽

Ammarin Thakkinstian

Keyword(s):

Systematic Review ◽

Cardiovascular Disease ◽

Cardiovascular Events ◽

Disease Risk ◽

Meta Analysis ◽

Cardiovascular Disease Risk ◽

Cvd Risk ◽

Neutrophil Lymphocyte Ratio ◽

Lymphocyte Ratio ◽

Coronary Syndrome

Objective. This systematic review aimed to measure the association between neutrophil lymphocyte ratio (NLR) and cardiovascular disease (CVD) risk. Methods. Relevant studies were identified from Medline and Scopus databases. Observational studies with NLR as a study factor were eligible for review. The outcomes of interest were any type of CVD including acute coronary syndrome, coronary artery disease, stroke, or a composite of these cardiovascular events. Mean differences in NLR between CVD and non-CVD patients were pooled using unstandardized mean difference (USMD). Odds ratios of CVD between high and low NLR groups were pooled using a random effects model. Results. Thirty-eight studies (n=76,002) were included. High NLR was significantly associated with the risks of CAD, ACS, stroke, and composite cardiovascular events with pooled ORs of 1.62 (95% CI: 1.38-1.91), 1.64 (95% CI: 1.30, 2.05), 2.36 (95% CI: 1.44, 2.89), and 3.86 (95% CI: 1.73, 8.64), respectively. In addition, mean NLRs in CAD, ACS, and stroke patients were significantly higher than in control groups. Conclusion. High NLR was associated with CAD, ACS, stroke, and composite cardiovascular events. Therefore, NLR may be a useful CVD biomarker.

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The frequency of uveitis in patients with adult versus childhood spondyloarthritis

RMD Open ◽

10.1136/rmdopen-2020-001196 ◽

2020 ◽

Vol 6 (2) ◽

pp. e001196

Author(s):

Matthew Turk ◽

Jacqueline Hayworth ◽

Tatiana Nevskaya ◽

Janet Pope

Keyword(s):

Systematic Review ◽

Random Effects ◽

Web Of Science ◽

Meta Analysis ◽

Ocular Involvement ◽

Random Effects Model ◽

Adult Onset ◽

Review Of The Literature ◽

Inclusion Criteria ◽

Random Effects Models

ObjectivesThis meta-analysis investigated the frequency of ocular involvement in childhood and adult spondyloarthritis (SpA).MethodsA systematic review of the literature was conducted. Medline, Web of Science and Cochrane databases were searched upto October 2018 identifying publications related to SpA, including ankylosing spondylitis (AS) with ocular conditions (OC) (uveitis, iritis, retinitis, chorioretinitis and other ocular involvement). The rates of OC were extracted and random effects models estimated their frequency. Heterogeneity was evaluated using I2. Inclusion criteria were studies in SpA of either children or adults who included a frequency of OC.Results3164 studies were identified, and 41 analysed which included frequencies of uveitis/iritis. Other OC were too infrequent to analyse. A pooled random effects model showed that the prevalence of uveitis was 24% in adult AS (23 studies, 11 943 patients), 10% in adult psoriatic arthritis (PsA) (9 studies, 1817) and 17% in undifferentiated adult SpA (9 studies, 6568 patients). In juveniles with AS, the prevalence of uveitis was 27% (8 studies, 927 patients), in juvenile PsA it was 16% (5 studies, N=498) and in juvenile undifferentiated SpA, uveitis occurred in 7% (2 studies, 1531 patients). In all evaluated SpA subgroups, there were no statistical differences in the frequency of uveitis between juveniles and adults.ConclusionsUveitis in adult versus child-onset SpA is similar in AS but more common in adult-onset undifferentiated SpA, and less frequent in adult-onset PsA compared to child-onset PsA, but the differences were not significant.

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The Risk of Secondary Malignancies in Patients with Ovarian Cancer: A Systematic Review and Meta-Analysis

10.1101/2020.04.07.20057190 ◽

2020 ◽

Author(s):

Keyvan Heydari ◽

Sahar Rismantab ◽

Reza Alizadeh-Navaei ◽

Amir Shamshirian ◽

Nima Shadmehri ◽

...

Keyword(s):

Breast Cancer ◽

Systematic Review ◽

Ovarian Cancer ◽

Cervical Cancer ◽

Connective Tissue ◽

Web Of Science ◽

Meta Analysis ◽

Secondary Malignancies ◽

Random Effects Models ◽

Increased Risk

AbstractThis study was performed to systematically asses the risk of secondary malignancies in patients with ovarian cancer. We conducted a systematic search in PubMed, Web of Science, and Scopus databases up to September 2019 to find target studies. In this study, the overall SIR has been calculated with fixed/random-effects models. Sixteen cohort studies including 122715 ovarian cancer patients with 4458 secondary malignancies have been included in this meta-analysis. Combined SIRs showed an increased risk of secondary malignancies prevalence (SIR: 1.81, 95%CI 1.58-2.03). The most prevalence diagnosed malignancies were as follows: breast cancer (1.34, 95%CI 1.5-1.18), intestine (2.36, 95%CI 1.11-3.61), colorectal (1.73, 95%CI 1.44-2.02), pancreatic (1.42, 95%CI 1.13-1.71), cervical cancer (11.57, 95%CI 6.94-16.21), renal (1.43, 95%CI 1.11-1.74), bladder (2.13, 95%CI 1.77-2.50), leukemia (3.33, 95%CI 2.23-4.43), connective tissue (2.61, 95%CI 1.56-3.66), and thyroid (1.59, 95%CI 1.13-2.04). In regards to the results, various malignancies have a greater prevalence in patients with ovarian cancer in comparison to the general public. Corpus cancer, leukemia cancer, endometrium cancer, connective tissue malignancy, and bladder cancer are among the high risks in these patients and need to be considered for them. Hence, the survival rate of the patients can be increased through prevention and early diagnosis.

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