Landry Matthew J, Senkus Katelyn E, Mangels A Reed, Guest Nanci S, Pawlak Roman, Raj Sudha, Handu Deepa, Rozga Mary
Department of Population Health and Disease Prevention, University of California, Program in Public Health, 856 Health Sciences Rd., Irvine, CA 92697, United States.
Department of Human Nutrition, The University of Alabama, Tuscaloosa, AL, United States.
Am J Prev Cardiol. 2024 Sep 28;20:100868. doi: 10.1016/j.ajpc.2024.100868. eCollection 2024 Dec.
Diet significantly influences the risk of developing cardiovascular disease (CVD), the leading cause of death in the United States. As vegetarian dietary patterns are increasingly being included within clinical practice guidelines, there is a need to review the most recent evidence regarding if and how these dietary patterns mitigate CVD risk.
This umbrella review of systematic reviews compared the relationships between vegetarian, vegan and non-vegetarian dietary patterns and CVD health outcomes and risk factors among presumably healthy adults (≥18 years) in the general population.
MEDLINE, CINAHL, Cochrane Databases of Systematic Reviews, Food Science Source and SportsDiscus databases were searched for systematic reviews (SRs) published from 2018 until March 2024. Eligible SRs and meta-analyses examined relationships between vegetarian or vegan diets and CVD risk factors and disease outcomes compared to non-vegetarian diets. SRs were screened in duplicate, and SR quality was assessed with AMSTAR2. The overall certainty of evidence (COE) was evaluated using the Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) method.
There were 758 articles identified in the databases' search and 21 SRs met inclusion criteria. SRs targeting the general population had primarily observational evidence. Vegetarian, including vegan, dietary patterns were associated with reduced risk for CVD incidence [Relative Risk: 0.85 (0.79, 0.92)] and CVD mortality [Hazard Ratio: 0.92 (0.85, 0.99)] compared to non-vegetarian diets. Vegan dietary patterns were associated with reductions in CVD risk factors including blood pressure [systolic mean difference (95 % CI): -2.56 mmHg (-4.66, -0.445)], low-density lipoprotein cholesterol [-0.49 mmol/l (-0.62, -0.36)], and body mass index [-1.72 kg/m (-2.30, -1.16)] compared to non-vegetarian dietary patterns, as well as c-reactive protein concentrations in a novel meta-analysis [-0.55 mg/l (-1.07, -0.03)].
Practitioners can consider recommending vegetarian dietary patterns to reduce cardiometabolic risk factors and risk of CVD incidence and mortality.
饮食对心血管疾病（CVD）的发生风险有显著影响，心血管疾病是美国的主要死因。随着素食饮食模式越来越多地被纳入临床实践指南，有必要回顾关于这些饮食模式是否以及如何降低心血管疾病风险的最新证据。
本系统评价的汇总分析比较了素食、纯素食和非素食饮食模式与一般人群中假定健康的成年人（≥18岁）的心血管疾病健康结局和风险因素之间的关系。
检索MEDLINE、CINAHL、Cochrane系统评价数据库、食品科学源数据库和体育数据库，查找2018年至2024年3月发表的系统评价（SRs）。符合条件的SRs和荟萃分析研究了素食或纯素食饮食与非素食饮食相比与心血管疾病风险因素和疾病结局之间的关系。SRs进行了重复筛选，并使用AMSTAR2评估SR质量。使用推荐分级、评估、制定和评价（GRADE）方法评估证据的总体确定性（COE）。
在数据库检索中识别出758篇文章，21篇SRs符合纳入标准。针对一般人群的SRs主要有观察性证据。与非素食饮食相比，素食（包括纯素食）饮食模式与心血管疾病发病率风险降低[相对风险：0.85（0.79，0.92）]和心血管疾病死亡率降低[风险比：0.92（0.85，0.99）]相关。与非素食饮食模式相比，纯素食饮食模式与心血管疾病风险因素降低相关，包括血压[收缩压平均差异（95%CI）：-2.56 mmHg（-4.66，-0.445）]、低密度脂蛋白胆固醇[-0.49 mmol/l（-0.62，-0.36）]和体重指数[-1.72 kg/m（-2.30，-1.16）]，以及一项新的荟萃分析中的C反应蛋白浓度[-0.55 mg/l（-1.07，-0.03）]。
从业者可以考虑推荐素食饮食模式以降低心脏代谢风险因素以及心血管疾病发病率和死亡率风险。
