Cardiovascular Disease

Better lifestyle practices are associated with decrease risk for of heart attack, stroke, as well many other cardiovascular complications.

Every year we lose thousands of lives to a preventable threat, cardiovascular disease. 

In the US, 49.2% of the adult population, or 126.9 million people, are living with cardiovascular disease in the form of coronary artery disease, heart failure, stroke, and hypertension 1.

Cardiovascular disease is the leading cause of death around the world and is the number one reason why us and our loved ones will someday die.

This is not a consequence of aging, in most cases it’s a consequence of poor lifestyle choices. 

Diet and lifestyle changes could prevent many of these cases. Diet, lifestyle, and psychosocial factors make up 90% of the risk of developing a heart attack or stroke 2 3. Here, we take a look at what cardiovascular disease is, and how a plant-based diet, along with other lifestyle factors, can delay, prevent and even reverse it.  

What is cardiovascular disease? 

Cardiovascular disease (CVD) is a term that describes several disorders affecting the heart and blood vessels. Coronary artery disease (CAD) is the most common type of heart disease in the US, where the coronary arteries get blocked by atherosclerotic plaques 4. This can lead to a heart attack, which is when a coronary artery gets completely blocked off by the atherosclerotic plaques. 

Stroke is responsible for 1 in 6 deaths caused by cardiovascular disease. It’s caused by a blockage of the blood vessels supplying the brain 5.

Other types of cardiovascular disease include heart failure, where your heart stops pumping blood as strongly as it should, as well as cardiomyopathies, cerebrovascular disease, peripheral artery disease, and deep vein thrombosis and pulmonary embolism. 

This information page will largely focus on coronary heart disease and stroke. 

What are the symptoms?

Symptoms can vary greatly between individuals and different conditions. 

Some people experience chest pain (angina) and shortness of breath when living with heart disease 6

Others may have no symptoms at all until they suffer a heart attack or heart failure. 

Symptoms of a heart attack include chest pain, shortness of breath, light-headedness, and pain in the arms, jaw, neck, and back. 

How can I get diagnosed with heart disease?

Various tests can be done by your doctor depending on what condition they think you may have. 

Some common tests to assess cardiovascular disease include:  

  • Electrocardiogram (ECG) - a test to check your heart's rhythm and electrical activity and detect any issues with these. It can diagnose coronary artery disease, cardiomyopathies, and heart attacks. 
  • Echocardiogram - a type of ultrasound that checks the structure of the heart and surrounding blood vessels. It can diagnose several heart conditions including heart failure, cardiomyopathies, and damage from a heart attack  
  • Stress test - a test that looks at how your heart responds to either exercise or medicine that raises your heart rate 
  • Blood tests - to assess the levels of various risk factors for heart disease, such as your cholesterol levels, triglycerides, and lipoprotein (a). 

What are the treatments available for cardiovascular disease?

The treatment options will depend on the specific type of cardiovascular disease a person is dealing with, treatments include

  • Medications, there are many types of medications available for people with CVD. For example, statins work by lowering cholesterol levels, and anticoagulants and antiplatelet agents decrease the clotting ability of the blood 
  • Surgery, for example a coronary artery bypass graft (CABG) treats blocked arteries by redirecting blood flow, and an angioplasty widens blocked arteries to improve their blood flow
  • Diet and lifestyle interventions, such an increasing physical activity or switching to a heart healthy diet  

Treatments usually aim to manage the symptoms, prevent the condition progressing any further, and prevent further complications such as a heart attack or stroke 

What increases my chances of developing heart disease?

In order to develop coronary artery disease, fatty, cholesterol-rich deposits accumulate in the walls of your coronary arteries, creating an atherosclerotic plaque. This cholesterol-rich gunk hardens the arteries. The process happens over many years, and as the plaque slowly builds up, it narrows the arteries more over time, until one day it may rupture, causing a blood clot in the artery and a subsequent heart attack. 

Various factors increase the risk of this happening. 

The risk factors for heart disease and stroke are those largely within our control: an unhealthy diet that is high in animal-derived and processed foods, physical inactivity, smoking, and excess alcohol consumption 1

High blood pressure (hypertension), high blood glucose, and blood lipid abnormalities are also major risk factors for cardiovascular disease. These are also heavily influenced by the diet and lifestyle factors described above.  

Age, gender, ethnicity, and genetics also impact the risk of developing cardiovascular disease, but these cannot be modified 6.  

How can a plant-based diet prevent cardiovascular disease?

The life-saving impacts of a plant-based diet are most pronounced for cardiovascular disease. There is a huge body of evidence that demonstrates how switching to a plant-based diet prevents cardiovascular disease. 

The first bit of evidence comes from rural China and Africa. Doctors and scientists discovered coronary heart disease was almost non-existent in these regions, which they attributed to people’s very low cholesterol levels. These regions shared commonalities in their diets: mostly plant-based, lots of fiber, and minimal animal products and fat. Scientists believed this to be the reason behind low levels of cholesterol and heart disease 7 8. When populations move from low-risk areas to high-risk areas like western countries, cardiovascular disease risk increases, suggesting the results are due to environmental factors like diet and lifestyle, not genetics 9 10.  

Western populations following modernized plant-based diets also have a reduced risk of heart disease. A study looking at Seventh-day Adventists from the US found a 40% reduced risk of coronary heart disease in vegetarians compared to non-vegetarians and a 29% reduction in cerebral vascular disease events (affecting the blood supply to the brain, including strokes) 11

Another study found those consuming plant-based diets had a 31% reduction in cardiovascular disease mortality compared to those eating a more omnivorous diet 12

So what contributes to the increased disease risk in omnivores? One major factor is red meat; a higher intake significantly increases the risk of heart disease 13. Red meat is high in saturated fat, and other harmful components which we discuss below. 

Here are the ways a plant-based diet can prevent cardiovascular disease, and maintain good cardiovascular health:

  1. Hypertension is a known risk factor for heart disease. Plant-based diets can reduce the risk of high blood pressure by up to 60% compared to an omnivorous diet 14. They are particularly effective when the diet is also low in salt. Read more about hypertension and plant-based diets here.
  2. High cholesterol is another significant risk factor for heart disease. In order to lower the ‘bad’ cholesterol in your blood, you need to reduce dietary saturated fat, trans fat, and to a lesser extent dietary cholesterol. Plant-based diets significantly lower blood total, LDL, HDL, and non-HDL cholesterol compared to omnivorous dietary patterns, and are naturally lower in saturated fat and cholesterol 15. Fiber, which is rich on a plant-based diet, also has cholesterol-lowering effects 16. Read more about plant-based diets and cholesterol here, 
  3. Saturated fat damages the lining of our gut, allowing bacteria to escape into our bloodstream and release harmful endotoxins. This causes inflammation and subsequent damage to our arteries, contributing to atherosclerosis and heart disease 17 18. Meat products, dairy, and processed foods are high in saturated fat. Saturated fat also raises LDL cholesterol, whereas unsaturated fats may be anti-inflammatory and lower CVD risk when replacing saturated fat in the diet 19. Plant-based diets are low in saturated fat, and higher in unsaturated fats. 
  4. Inflammation and oxidative stress, oxidative stress is a key part of atheroscletoric plaque formation. Plant foods are rich in polyphenols and other nutrients (vitamins C, E and beta-carotene) that are strong antioxidants and protect against oxidative stress. Antioxidants may also limit the oxidation of LDL-cholesterol which is also involved in atherosclerosis 20. Several components of animal foods, such as heme iron found in red meat and poultry, are pro-oxidative and contribute to increased risk of CVD 19
  5. TMAO, short for trimethylamine-N-oxide. Microbes in the gut can convert choline and L-carnitine, found in red meat, poultry, fish, eggs, and milk to a metabolite called TMAO, which promotes atherosclerosis and cardiovascular disease 21 22. This is not seen with the consumption of plant foods. 

Other benefits of plant foods for cardiovascular health include: 

  • Bioactive polyphenols can increase nitric oxide production which helps to relax the blood vessels and improve blood flow 23
  • Potassium, found in many plant foods, supports good endothelial function, lowering blood pressure and the risk of stroke 24
  • Magnesium also helps to maintain cardiovascular health. It supports insulin sensitivity, is anti-inflammatory, and is a natural vasodilator which helps with blood flow 25

What about reversing cardiovascular disease on a plant-based diet?

It’s never too late to switch to a plant-based diet. On a whole-food plant-based diet, not only can you stop heart disease in its tracks, you may be able to reverse it. 

A low-fat plant-based diet is the only diet shown to actually reverse heart disease in some patients 26 27 28 (Ornish et al.1990). Some studies combined a plant-based diet with exercise and stress management to reverse heart disease 28.  

When participants were switched to a whole-food plant-based diet, the foods causing harm to the cardiovascular system were cut out of their diet. This included saturated fat and cholesterol, food that damages endothelial cells, and TMAO. The participants' bodies were given a chance to heal; to improve endothelial function, and restore blood flow. And what did the researchers see? Those people started to get better 26.

So, when the artery-clogging diet stops, so does the artery-clogging itself, and some of the plaque actually begins to dissolve away. 

The participants of the study were also provided with nutrition counseling, recipes and strategies for going plant-based, helping them to make and maintain the transition.  

This is different to any medication your doctor can offer - it doesn’t just mask the disease, it treats the root cause and allows you to actually heal. 

References 

1. Virani, S. S. et al. Heart Disease and Stroke Statistics—2021 Update: A Report From the American Heart Association. Circulation 143, (2021).

2. Yusuf, S. et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. The Lancet 364, 937–952 (2004).

3. O’Donnell, M. J. et al. Global and regional effects of potentially modifiable risk factors associated with acute stroke in 32 countries (INTERSTROKE): a case-control study. The Lancet 388, 761–775 (2016).

4. CDC. Coronary Artery Disease | cdc.gov. Centers for Disease Control and Prevention https://www.cdc.gov/heartdisease/coronary_ad.htm (2021).

5. CDC. Stroke Facts | cdc.gov. Centers for Disease Control and Prevention https://www.cdc.gov/stroke/facts.htm (2022).

6. Gaziano, T., Reddy, K. S., Paccaud, F., Horton, S. & Chaturvedi, V. Cardiovascular Disease. Disease Control Priorities in Developing Countries. 2nd edition (The International Bank for Reconstruction and Development / The World Bank, 2006).

7. Shaper, A. G. & Jones, K. W. Serum-cholesterol, diet, and coronary heart-disease in Africans and Asians in Uganda*. Int. J. Epidemiol. 41, 1221–1225 (2012).

8. Campbell, T. C., Parpia, B. & Chen, J. Diet, lifestyle, and the etiology of coronary artery disease: the Cornell China Study. Am. J. Cardiol. 82, 18–21 (1998).

9. Benfante, R. Studies of cardiovascular disease and cause-specific mortality trends in Japanese-American men living in Hawaii and risk factor comparisons with other Japanese populations in the Pacific region: a review. Hum. Biol. 64, 791–805 (1992).

10. Greger, M. & Stone, G. How not to die: discover the foods scientifically proven to prevent and reverse disease. (Pan Books, 2018).

11. Kwok, C. S., Umar, S., Myint, P. K., Mamas, M. A. & Loke, Y. K. Vegetarian diet, Seventh Day Adventists and risk of cardiovascular mortality: A systematic review and meta-analysis. Int. J. Cardiol. 176, 680–686 (2014).

12. Kim, H. et al. Plant‐Based Diets Are Associated With a Lower Risk of Incident Cardiovascular Disease, Cardiovascular Disease Mortality, and All‐Cause Mortality in a General Population of Middle‐Aged Adults. J. Am. Heart Assoc. 8, e012865 (2019).

13. Bernstein, A. M. et al. Major Dietary Protein Sources and Risk of Coronary Heart Disease in Women. Circulation 122, 876–883 (2010).

14. Pettersen, B. J., Anousheh, R., Fan, J., Jaceldo-Siegl, K. & Fraser, G. E. Vegetarian diets and blood pressure among white subjects: results from the Adventist Health Study-2 (AHS-2). Public Health Nutr. 15, 1909–1916 (2012).

15. Wang, F. et al. Effects of Vegetarian Diets on Blood Lipids: A Systematic Review and Meta‐Analysis of Randomized Controlled Trials. J. Am. Heart Assoc. 4, e002408 (2015).

16. Brown, L., Rosner, B., Willett, W. W. & Sacks, F. M. Cholesterol-lowering effects of dietary fiber: a meta-analysis. Am. J. Clin. Nutr. 69, 30–42 (1999).

17. López-Moreno, J. et al. Effect of Dietary Lipids on Endotoxemia Influences Postprandial Inflammatory Response. J. Agric. Food Chem. 65, 7756–7763 (2017).

18. Bowman, J. D., Surani, S. & Horseman, M. A. Endotoxin, Toll-like Receptor-4, and Atherosclerotic Heart Disease. Curr. Cardiol. Rev. 13, (2017).

19. Satija, A. & Hu, F. B. Plant-based diets and cardiovascular health. Trends Cardiovasc. Med. 28, 437–441 (2018).

20. Tangney, C. C. & Rasmussen, H. E. Polyphenols, Inflammation, and Cardiovascular Disease. Curr. Atheroscler. Rep. 15, 324 (2013).

21. Koeth, R. A. et al. Intestinal microbiota metabolism of l-carnitine, a nutrient in red meat, promotes atherosclerosis. Nat. Med. 19, 576–585 (2013).

22. Tang, W. H. W. et al. Intestinal Microbial Metabolism of Phosphatidylcholine and Cardiovascular Risk. N. Engl. J. Med. 368, 1575–1584 (2013).

23. Quiñones, M., Miguel, M. & Aleixandre, A. Beneficial effects of polyphenols on cardiovascular disease. Pharmacol. Res. 68, 125–131 (2013).

24. Aburto, N. J. et al. Effect of increased potassium intake on cardiovascular risk factors and disease: systematic review and meta-analyses. BMJ 346, f1378–f1378 (2013).

25. Kolte, D., Vijayaraghavan, K., Khera, S., Sica, D. A. & Frishman, W. H. Role of magnesium in cardiovascular diseases. Cardiol. Rev. 22, 182–192 (2014).

26. Esselstyn Jr, C. B., Gendy, G., Doyle, J., Golubic, M. & Roizen, M. F. A way to reverse CAD? J. Fam. Pract. 63, 356–364 (2014).

27. Ornish, D. Intensive Lifestyle Changes for Reversal of Coronary Heart Disease. JAMA 280, 2001 (1998).

28. Ornish, D. et al. Effects of stress management training and dietary changes in treating ischemic heart disease. JAMA 249, 54–59 (1983).

29. Ornish, D. et al. Can lifestyle changes reverse coronary heart disease? The Lancet 336, 129–133 (1990).

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