• An analysis of prospective data from a community-based cohort of African American adults in the Jackson Heart Study. Participants were assigned scores to 3 plant-based dietary patterns: an overall plant-based diet index (PDI), a healthy PDI (hPDI), and an unhealthy PDI (uPDI).
  • Over a median follow-up of 13 and 15 years, there were 293 incident CVD cases and 597 deaths, respectively. After adjusting for sociodemographic characteristics and health behaviours, no significant association was observed between plant-based diets and incident CVD, all-cause mortality, incident coronary heart disease and total stroke for overall PDI, hPDI and uPDI.
  • Overall diet quality was low for all participants, and participants with the most plant-rich diets still regularly included animal-based foods.
  • Among individual food groups, legumes were associated with a lower risk for CVD, while vegetable oils were associated with higher risk for CVD, and whole grains and sugar-sweetened beverages were associated with higher all-cause mortality.
  • This study, unlike in prior studies, found greater adherence to a plant-based diet was not associated with CVD or all-cause mortality.



  • One limitation of this study is the use of self-reported dietary intake, which may result in measurement error. 
  • Additionally, while the study adjusted for many sociodemographic and behavioural factors and relevant medical history, it may still be limited by residual confounding.
  • Reverse causation may also be a potential concern if participants at higher risk for CVD had intentionally adopted a more plant-based dietary pattern.
  • The number of incident CVD cases was relatively small (293 CVD cases out of 3,536 participants), thus may lack sufficient power.


Question to members

  • What are the strengths and limitations of using plant-based diet index scores?



Weston, L.J., Kim, H., Talegawkar, S.A., Tucker, K.L., Correa, A. and Rebholz, C.M. Plant-based diets and incident cardiovascular disease and all-cause mortality in African Americans: A cohort study. PLoS medicine. 2022

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