Plant-based Diets, Cardiovascular Disease, and Healthy Aging

The adage ‘you are what you eat’ is often used to indicate that eating healthy food can help you be fit and healthy and prevent cardiovascular disease (CVD). Learn about the connections between plant-based diets, CVD, and healthy aging in this article by PCNA contributors Tricia VanCleef and Emily J. Jones.

Cardiovascular Disease and Aging

Cardiovascular disease (CVD) is the leading cause of death worldwide, and this is especially true for older adults, both in the U.S. and globally.^3,4 An unhealthy diet is a well-recognized cause of CVD.⁴ Diets that include a high intake of cholesterol and unhealthy fats, such as the Southern diet, are associated with an increased risk of CVD and premature mortality. ⁵ Even a slightly elevated LDL-C level can predict CVD in later years, contributing to a high risk for CVD among older adults.⁶

What is a Plant-based Diet?

A plant-based diet is one that includes foods mainly derived from plants, with the intake of minimal or no foods derived from animals.¹ Foods derived from plants include fruits, vegetables, whole grains, legumes or beans, nuts, and seeds. Animal-derived foods include meat (e.g., poultry, beef, and pork), fish, eggs, and dairy (e.g., cheese, milk, and yogurt).

There are various ways of engaging in a plant-based diet lifestyle. Examples of plant-based dietary patterns include vegans, vegetarians, flexitarians, and pescatarians.²

• Vegans exclude all food and byproducts derived from animals.
• Vegetarians do not eat meat, poultry, or seafood, but may consume dairy (lacto-vegetarian), eggs (ovo-vegetarian), or both (lacto-ovo vegetarian).
• Pescatarians eat mostly plant-derived foods but also include some fish.
• Flexitarians mostly eat plant-derived foods, but also include some meat, poultry, dairy, eggs, and seafood.

Regardless of the type of plant-based diet, the main concept is that most of the food eaten is plant-derived, with animal-derived foods being absent or ingested in small amounts.

The Association Between Plant-based Diets and Decreased Risk of CVD

An unhealthy diet is linked with risk factors for CVD, such as hypertension and obesity.⁴ Diets high in animal-based saturated fats and proteins have been shown to increase the risk of CVD.⁷ The human body produces the cholesterol it needs for metabolic (cellular and hormonal) processes. When eating foods containing cholesterol that is derived from animals, the body absorbs the excess cholesterol which increases the risk of CVD due to atherosclerosis.⁸ Eating animal-based foods increases cholesterol levels in the body.⁹ Additionally, diets containing a large amount of animal-based protein increase the risk of cardiovascular mortality.¹⁰

In contrast, nutritionally-balanced plant-based diets have been shown to reduce the risk of CVD and stroke, including a reduction in blood pressure and cholesterol levels.^6,10 Diets containing a large amount of plant-based protein decrease the risk of cardiovascular mortality.¹⁰  When a plant-based diet is combined with other lifestyle changes, CVD may even be reversed, including a reduction in atherosclerosis, cholesterol levels, coronary events, blood pressure, and ischemia.^6,12-15 Plant-based diets may not only slow the aging process but also may improve the quality and quantity of the lifespan.¹⁴  

Plant-based Diets, CVD, and Older Adults

Replacing even a few servings of animal-based foods with plant-based foods can have a beneficial effect on CVD outcomes over the long term.¹⁵ Plant-based diets are cost-effective, and interventions to educate older adults about the benefits are low-risk.¹⁷ Despite the research showing the benefits of plant-based diets, many dietary guidelines do not emphasize the benefits of this lifestyle. Additionally, transitioning to a plant-based diet can be confusing for patients, especially for those who may not understand what a nutritionally-balanced diet should entail.¹⁸ Putting educational materials in waiting rooms, discussing the topic with patients, and connecting patients with community resources such as cooking classes geared towards plant-based diets, are all steps that can be taken to help older adults make lifestyle changes to improve CVD risk and outcomes.¹²

Older adults may have unique and complex medical conditions, beliefs, values, socioeconomic, and cultural backgrounds, so a successful transition to a nutritionally-balanced plant-based diet requires individualized approaches. Older adults need continuous support and education related to a plant-based diet lifestyle change to improve autonomy and internal motivation, and these measures will increase the chances of a long-term diet change.¹⁸ Additionally, older adults are at risk for malnutrition, regardless of diet, due to age-related changes in the body, so working with a Registered Dietician can help ensure a successful transition to a well-rounded, nourishing plant-based diet lifestyle.^17,18

Implications for Nurses

1. A plant-based diet is one that includes foods mainly derived from plants and minimal or no foods derived from animals.
2. Educating and encouraging older adults to transition to a healthy plant-based diet lifestyle can reduce the risk of cardiovascular disease and even reverse it.
3. Nurses can learn more about plant-based diets through various reputable websites, including NutritionFacts.org, the Physicians Committee for Responsible Medicine, and The Plantrician Project.
4. To help promote plant-based diets, nurses can take courses in plant-based nutrition, such as through the T. Colin Campbell Center for Nutrition Studies partnership with eCornell, and can also attend conferences, such as the Plant-Based Prevention of Disease (P-POD) conference.
5. There are many books, podcasts, and documentaries that can provide information to nurses on plant-based diets, including How Not to Diet by Dr. Michael Greger, The Game Changers on Netflix, and the NutritionFacts podcast.
6. Nurses can also become diplomats for the American College of Lifestyle Medicine (ACLM), where taking courses and attending conferences in plant-based nutrition are required before sitting for boards.
7. When referring patients to a dietician or other healthcare provider for help with a successful transition to a plant-based diet, it may be helpful to search for professionals that are certified in lifestyle medicine through the American College of Lifestyle Medicine.
8. Nurses can get involved in advocating for policies that make healthy food more affordable by joining or supporting organizations that engage with these issues, such as the American Public Health Association and the Food Research and Action Center, as well as promoting the use of assistance programs such as the Supplemental Nutrition Assistance Program (SNAP) and partnering with local farmers and public health agencies to provide low-cost healthy food options to the local community.

Related Resources

• CE Course – Behavior Change Principles in Action: Helping Patients Set Goals and Follow a Heart-Healthy Eating Plan
• CE Course – Optimal Nutrition for Cardiovascular Risk Reduction
• Heart Healthy Toolbox (pages 15-18)

References

1. Toledano, S. (2022). What is a plant-based diet, and is it healthy? Columbia University.
2. British Dietetic Association. (2021). Vegetarian, vegan and plant-based diet. The Association of UK Dietitians. (PDF)
3. Centers for Disease Control and Prevention. (2022). Older persons’ health.
4. World Health Organization. (2021a). Cardiovascular diseases (CVDs).
5. Shikany JM, Safford MM, Bryan J, et al. (2018). Dietary patterns and Mediterranean diet score and hazard of recurrent coronary heart disease events and all‐cause mortality in the REGARDS study. Journal of the American Heart Association, 7(14).
6. Virani SS, Alonso A, Aparicio HJ, et al. (2021). Heart disease and stroke statistics. Circulation, 143, e254–e743.
7. Zhong VW, Allen NB, Greenland P, et al. (2021). Protein foods from animal sources, incident cardiovascular disease and all-cause mortality: a substitution analysis. Int J Epidemiol, 50(1). 223-233.
8. American Heart Association. (2020, November 6). What is cholesterol?
9. Bergeron N, Chiu S, Williams PT, King SM, Krauss RM. (2019). Effects of red meat, white meat, and nonmeat protein sources on atherogenic lipoprotein measures in the context of low compared with high saturated fat intake: a randomized controlled trial. The American Journal of Clinical Nutrition, 110(1), 24-33.
10. Tharrey M, Mariotti F, Mashchak A, Barbillon P, Delattre M, Fraser GE. (2018). Patterns of plant and animal protein intake are strongly associated with cardiovascular mortality: the Adventist Health Study-2 cohort. International Journal of Epidemiology, 47(5), 1603-1612.
11. Baden MY, Shan Z, Wang F, et al. (2021). Quality of Plant-Based Diet and Risk of Total, Ischemic, and Hemorrhagic Stroke. Neurology, 96(15), e1940.
12. Barnard ND, Levin SM, Gloede L, Flores R. (2018). Turning the waiting room into a classroom: Weekly classes using a vegan or a portion-controlled eating plan Improve diabetes control in a randomized translational study. Journal of the Academy of Nutrition and Dietetics, 118(6), 1072–1079.
13. Huang T, Yang B, Zheng J, Li G, Wahlqvist ML, Li, D. (2012). Cardiovascular disease mortality and cancer incidence in vegetarians: A meta-analysis and systematic review. Annals of Nutrition and Metabolism, 60(4), 233–240.
14. Kahleova H, Levin S, Barnard ND. (2021). Plant-based diets for healthy aging. Journal of the American College of Nutrition, 40(5), 478–479.
15. Li SS., Blanco Mejia S, Lytvyn L, et al. (2017). Effect of plant protein on blood lipids: A systematic review and meta‐analysis of randomized controlled trials. Journal of the American Heart Association, 6(12).
16. Tuso PJ, Ismail MH, Ha BP, Bartolotto C. (2013). Nutrition update for physicians: Plant-based diets. Perm J, 17(2), 61-66.
17. Avgerinou C, Bhanu C, Walters K, et al. (2019). Exploring the views and dietary practices of older people at risk of malnutrition and their carers: A qualitative study. Nutrients, 11(6), 1281.
18. James A, Lawrence B, O’Connor M (2022). Healthy eating as a new way of life: A qualitative study of successful long-term diet change. INQUIRY: The Journal of Health Care Organization, Provision, and Financing, 59, 004695802210903.