People with high cholesterol could significantly reduce their risk of cardiovascular disease by following a vegan or vegetarian diet. This is the result of an overview work by Danish physicians who evaluated studies from four decades. However, as experts point out in a comment, the benefits of a plant-based diet are not necessarily enough to make you avoid medication. And: Not all meatless diets are actually healthy.
Specifically, the doctors at Rigshospitalet in Copenhagen analyzed 30 randomized studies with a total of over 2,300 participants that were published between 1982 and 2022. These studies looked at the effects of a vegetarian or vegan diet compared to an omnivorous diet on levels of things like low-density lipoprotein (LDL) cholesterol, which are thought to be harmful, triglycerides, a type of fat in the blood, and apoliprotein B (ApoB). . This protein supports the transport of fat and cholesterol in the blood. According to several studies, it is a better indicator of the risk of cardiovascular disease than LDL cholesterol, for example.
The meta-analysis published in the European Heart Journal found that people who ate a plant-based diet reduced their total cholesterol levels by an average of 7 percent compared to the levels measured at the start of the studies. The LDL cholesterol value fell by 10 percent, the AboB level by 14 percent.
Plant-based foods are good for the heart and the environment
“This is one-third the effect of cholesterol-lowering drugs like statins and would result in a seven percent reduction in cardiovascular disease risk in someone who maintains a plant-based diet for five years,” said co-author Ruth Frikke-Schmidt.
If people were to eat a vegetarian or vegan diet from a young age, the risk of cardiovascular diseases caused by clogged arteries could even drop significantly. “It is important that we found similar results on all continents, in all age groups, in different body mass index ranges and in people with different health conditions,” emphasizes Frikke-Schmidt.
“Including more plant-based foods in your diet is good for your heart and the environment,” said Tracy Parker of the British Heart Foundation in an independent review. However, some people may find it easier to follow a Mediterranean diet high in fruits, vegetables, legumes, whole grains, fish, eggs, and low-fat dairy products and eat only small amounts of meat. “There’s a lot of evidence that this type of diet can help reduce the risk of cardiovascular disease by improving cholesterol and blood pressure levels, reducing inflammation, and controlling blood sugar levels,” says Parker.
Influence of diet is limited
However, the meta-analysis also indicates that the influence of diet on cholesterol levels is limited, emphasizes Robert Storey from the University of Sheffield. High cholesterol is more influenced by genes than by diet, says the cardiologist, who was not involved in the study. “This explains why statins are needed to block cholesterol production in people who are at higher risk of heart attack, stroke, or another disease related to cholesterol buildup in blood vessels.”
Frikke-Schmidt also emphasizes that statins are superior to a plant-based diet for lowering fat and cholesterol levels. However, one does not exclude the other: “The combination of statins and plant-based nutrition should have a synergy effect that leads to an even greater positive effect.”
In a commentary in the European Heart Journal, Kevin Maki and Carol Kirkpatrick of Midwest Biomedical Research write that not all plant-based diets are created equal: “Not all vegan and vegetarian diets are healthy, especially when they include excessive amounts of food and drink with added sugar and refined grains.”
Further studies necessary
For Maki and Kirkpatrick, the inclusion of ApoB in particular is a strength of the Danish review work. However, only six of the 30 studies considered contained information on the apoliprotein: further longer-term studies are required here, which, in addition to ApoB, also include other biomarkers for inflammation and insulin resistance, for example.
Overall, however, the meta-analysis confirms the benefits of a vegetarian or vegan diet. “While it is not necessary to completely eliminate foods such as meat, poultry, and fish/seafood in order to follow recommended dietary patterns,” they write. But reducing your intake of such foods is a sensible option.