Abstract

Background: The effect of a whole-food plant-based vegan diet vs an AHA-recommended diet on inflammatory, lipid, and glucometabolic profiles remains uncertain.

Methods: This prospective blinded end-point trial randomized 100 patients with invasive angiographically-defined coronary artery disease (CAD) to 8 weeks of a vegan or AHA diet. Participants were provided weekly groceries for their assigned diet strategy, sample 2-week menus, tools to measure portion size, and on-going consultation with the study dietitian. Dietary adherence was measured by two weekly 24-hour dietary recalls and plasma and urine trimethylamine-N-oxide levels. Participants also completed a 4-day food record during the week prior to the baseline, 4-, and 8-week study visits. The primary endpoint was serum hsCRP concentration. A linear mixed effect model was used to model the log-transformed endpoints (to correct for skewness), evaluate the change in endpoint over time within treatment group, and test the interaction between time and treatment. The primary analysis was also covariate-adjusted.

Results: Baseline characteristics are shown in Table 1. Two subjects withdrew from the vegan group after randomization, but dietary adherence remained higher in the vegan vs AHA group at the 4-week (96% vs 84%, p=0.09) and 8-week (94% vs 70%, p=0.003) visits. Endpoints are shown in Table 2.

Conclusion: A vegan diet significantly reduced systemic inflammation, as evidenced by hsCRP, in patients with CAD on guideline-directed medical therapy, while an AHA diet did not. This is the first rigorous study to comprehensively assess multiple indices of cardiovascular risk between a vegan and AHA diet.