Plant-based diet and its effect on coronary artery disease: A narrative review

Abstract

Coronary artery disease (CAD), a primary component of cardiovascular diseases, is one of the top contributors to mortality rates worldwide. In 2021, dietary risk was estimated to be attributed to 6.58 million cardiovascular deaths. Plant-based diets (PBDs), which encourage higher consumption of plant foods and lower intake of animal-based foods, have been shown to reduce the risk of CAD by up to 29% when compared to non-vegetarian diets in a meta-analysis. This article aims to summarize the array of PBDs and compare them with conventional Western diets that include meat. We review the various proposed mechanisms for how the bioactive nutrients of PBDs aid in preventing atherosclerosis and CAD events, as well as other cardiac diseases. We conducted a detailed search of PubMed using our exclusive search strategy using the keywords plant-based diet, vegan diet, phytosterols, CAD, myocardial ischemia, and atherosclerosis. A total of 162 pertinent articles published within the past decade were identified for qualitative synthesis. To ensure the accuracy and reliability of our review, we included a total of 55 full-text, peer-reviewed articles that demonstrated the effects of plant-based diets on CAD and were written in English. We excluded animal studies, in vitro or molecular studies, and non-original data like editorials, letters, protocols, and conference abstracts. In this article, we emphasize the importance of dietary interventions, such as PBDs, to prevent CAD and their benefits on environmental sustainability. Integrating plant foods and whole grains into one's daily eating habits leads to an increase in the intake of nutrient-rich foods while reducing the consumption of processed food could not only prevent millions of premature deaths but also provide prevention against many chronic gastrointestinal and metabolic diseases.

Keywords: Plant-based diet; Phytosterol; Coronary artery disease; Low-density lipoprotein-cholesterol; Micronutrients; Atherosclerosis

Core Tip: The prevailing fund of knowledge depicts that a high salt diet or a Western diet that contains excessive saturated fats, and meat augments inflammation, oxidation, and atherogenic activity in our body. The American Heart Association and European Atherosclerotic Society both recommend consuming more fruits, vegetables, dietary fibers, and nuts that are all integral to plant-based diets in order to prevent the progression of coronary artery disease (CAD). However, we could not find an article that provided a comprehensive review of a variety of bioactive nutrients in these diets, comparing several types of diets and their effects on diverse metabolic conditions like diabetes, hyperlipidemia, and atrial fibrillation, amongst others. We, thus, author a narrative review to compile the proposed effect of each nutrient, antioxidant as well as various diets on CAD in adults.