Vegetarian diet, Seventh Day Adventists and risk of cardiovascular mortality

a systematic review and meta-analysis

Chun Shing Kwok, Saadia Umar, Phyo K Myint, Mamas A Mamas, Yoon K Loke

Research output: Contribution to journalArticle

58 Citations (Scopus)

Abstract

BACKGROUND: Dietary interventions are an important component of cardiovascular risk factor management although their impact on cardiovascular risk and mortality remains uncertain. We have studied influence of a vegetarian diet on cardiovascular risk and mortality.

METHODS: We searched MEDLINE and EMBASE for comparative studies that evaluated clinical outcomes associated with vegetarian diet as compared to non-vegetarian controls or the general population. Relevant studies were pooled using random effects meta-analysis for risk of death, ischaemic heart disease (IHD) and cerebrovascular disease. We conducted subgroup analysis according to specific type of cohort (e.g. Seventh Day Adventist [SDA]) and gender.

RESULTS: Eight studies met the inclusion criteria with 183,321 participants (n=183,321). There was significant heterogeneity in all the meta-analyses, particularly evident with the studies of SDA. In all instances, we found that SDA studies showed greater effect size as compared to non-SDA studies: death (RR 0.68 95% CI 0.45-1.02 vs RR 1.04 95% CI 0.98-1.10), ischaemic heart disease (IHD) (RR 0.60 95% CI 0.43-0.80 vs RR 0.84 95% CI 0.74-0.96) and cerebrovascular disease (RR 0.71 95% CI 0.41-1.20 vs RR 1.05 95% CI 0.89-1.24). Sex specific analyses showed that IHD was significantly reduced in both genders but risk of death and cerebrovascular disease was only significantly reduced in men.

CONCLUSIONS: Data from observational studies indicates that there is modest cardiovascular benefit, but no clear reduction in overall mortality associated with a vegetarian diet. This evidence of benefit is driven mainly by studies in SDA, whereas the effect of vegetarian diet in other cohorts remains unproven.

Original languageEnglish
Pages (from-to)680-686
Number of pages7
JournalInternational Journal of Cardiology
Volume176
Issue number3
Early online date4 Aug 2014
DOIs
Publication statusPublished - 20 Oct 2014

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Vegetarian Diet
Cerebrovascular Disorders
Meta-Analysis
Myocardial Ischemia
Mortality
Risk Management
MEDLINE
Observational Studies
Population

Keywords

  • vegetarian
  • cardiovascular disease
  • ischaemic heart disease
  • stroke
  • mortality

Cite this

Vegetarian diet, Seventh Day Adventists and risk of cardiovascular mortality : a systematic review and meta-analysis. / Kwok, Chun Shing; Umar, Saadia; Myint, Phyo K; Mamas, Mamas A; Loke, Yoon K.

In: International Journal of Cardiology, Vol. 176, No. 3, 20.10.2014, p. 680-686.

Research output: Contribution to journalArticle

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abstract = "BACKGROUND: Dietary interventions are an important component of cardiovascular risk factor management although their impact on cardiovascular risk and mortality remains uncertain. We have studied influence of a vegetarian diet on cardiovascular risk and mortality.METHODS: We searched MEDLINE and EMBASE for comparative studies that evaluated clinical outcomes associated with vegetarian diet as compared to non-vegetarian controls or the general population. Relevant studies were pooled using random effects meta-analysis for risk of death, ischaemic heart disease (IHD) and cerebrovascular disease. We conducted subgroup analysis according to specific type of cohort (e.g. Seventh Day Adventist [SDA]) and gender.RESULTS: Eight studies met the inclusion criteria with 183,321 participants (n=183,321). There was significant heterogeneity in all the meta-analyses, particularly evident with the studies of SDA. In all instances, we found that SDA studies showed greater effect size as compared to non-SDA studies: death (RR 0.68 95{\%} CI 0.45-1.02 vs RR 1.04 95{\%} CI 0.98-1.10), ischaemic heart disease (IHD) (RR 0.60 95{\%} CI 0.43-0.80 vs RR 0.84 95{\%} CI 0.74-0.96) and cerebrovascular disease (RR 0.71 95{\%} CI 0.41-1.20 vs RR 1.05 95{\%} CI 0.89-1.24). Sex specific analyses showed that IHD was significantly reduced in both genders but risk of death and cerebrovascular disease was only significantly reduced in men.CONCLUSIONS: Data from observational studies indicates that there is modest cardiovascular benefit, but no clear reduction in overall mortality associated with a vegetarian diet. This evidence of benefit is driven mainly by studies in SDA, whereas the effect of vegetarian diet in other cohorts remains unproven.",
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T1 - Vegetarian diet, Seventh Day Adventists and risk of cardiovascular mortality

T2 - a systematic review and meta-analysis

AU - Kwok, Chun Shing

AU - Umar, Saadia

AU - Myint, Phyo K

AU - Mamas, Mamas A

AU - Loke, Yoon K

N1 - Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

PY - 2014/10/20

Y1 - 2014/10/20

N2 - BACKGROUND: Dietary interventions are an important component of cardiovascular risk factor management although their impact on cardiovascular risk and mortality remains uncertain. We have studied influence of a vegetarian diet on cardiovascular risk and mortality.METHODS: We searched MEDLINE and EMBASE for comparative studies that evaluated clinical outcomes associated with vegetarian diet as compared to non-vegetarian controls or the general population. Relevant studies were pooled using random effects meta-analysis for risk of death, ischaemic heart disease (IHD) and cerebrovascular disease. We conducted subgroup analysis according to specific type of cohort (e.g. Seventh Day Adventist [SDA]) and gender.RESULTS: Eight studies met the inclusion criteria with 183,321 participants (n=183,321). There was significant heterogeneity in all the meta-analyses, particularly evident with the studies of SDA. In all instances, we found that SDA studies showed greater effect size as compared to non-SDA studies: death (RR 0.68 95% CI 0.45-1.02 vs RR 1.04 95% CI 0.98-1.10), ischaemic heart disease (IHD) (RR 0.60 95% CI 0.43-0.80 vs RR 0.84 95% CI 0.74-0.96) and cerebrovascular disease (RR 0.71 95% CI 0.41-1.20 vs RR 1.05 95% CI 0.89-1.24). Sex specific analyses showed that IHD was significantly reduced in both genders but risk of death and cerebrovascular disease was only significantly reduced in men.CONCLUSIONS: Data from observational studies indicates that there is modest cardiovascular benefit, but no clear reduction in overall mortality associated with a vegetarian diet. This evidence of benefit is driven mainly by studies in SDA, whereas the effect of vegetarian diet in other cohorts remains unproven.

AB - BACKGROUND: Dietary interventions are an important component of cardiovascular risk factor management although their impact on cardiovascular risk and mortality remains uncertain. We have studied influence of a vegetarian diet on cardiovascular risk and mortality.METHODS: We searched MEDLINE and EMBASE for comparative studies that evaluated clinical outcomes associated with vegetarian diet as compared to non-vegetarian controls or the general population. Relevant studies were pooled using random effects meta-analysis for risk of death, ischaemic heart disease (IHD) and cerebrovascular disease. We conducted subgroup analysis according to specific type of cohort (e.g. Seventh Day Adventist [SDA]) and gender.RESULTS: Eight studies met the inclusion criteria with 183,321 participants (n=183,321). There was significant heterogeneity in all the meta-analyses, particularly evident with the studies of SDA. In all instances, we found that SDA studies showed greater effect size as compared to non-SDA studies: death (RR 0.68 95% CI 0.45-1.02 vs RR 1.04 95% CI 0.98-1.10), ischaemic heart disease (IHD) (RR 0.60 95% CI 0.43-0.80 vs RR 0.84 95% CI 0.74-0.96) and cerebrovascular disease (RR 0.71 95% CI 0.41-1.20 vs RR 1.05 95% CI 0.89-1.24). Sex specific analyses showed that IHD was significantly reduced in both genders but risk of death and cerebrovascular disease was only significantly reduced in men.CONCLUSIONS: Data from observational studies indicates that there is modest cardiovascular benefit, but no clear reduction in overall mortality associated with a vegetarian diet. This evidence of benefit is driven mainly by studies in SDA, whereas the effect of vegetarian diet in other cohorts remains unproven.

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KW - cardiovascular disease

KW - ischaemic heart disease

KW - stroke

KW - mortality

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EP - 686

JO - International Journal of Cardiology

JF - International Journal of Cardiology

SN - 0167-5273

IS - 3

ER -