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New research shows that vegetarian and vegan diets are associated with reduced concentrations of total cholesterol, low-density lipoprotein cholesterol, and apolipoprotein B.
The analysis, published in the European Heart Journal, reviewed 30 randomised trials with a total of 2,372 participants, published between 1982 and 2022, that quantified the effect of vegetarian or vegan diets versus omnivorous diets on levels of all types of cholesterol (total cholesterol), low-density lipoprotein cholesterol, triglycerides and apoliprotein B.
The authors, Professor Ruth Frikke-Schmidt, Chief Physician at the Rigshospitalet in Copenhagen, Denmark, who conducted the study together with medical student Ms Caroline Amalie Koch and Dr Emilie Westerlin Kjeldsen, concluded that plant-based diets can play a significant role in reducing blocked arteries, thereby lowering the risk of heart and blood vessel diseases, such as stroke and heart attacks.
Professor Rigshospitalet said: “We found that vegetarian and vegan diets were associated with a 14% reduction in all artery-clogging lipoproteins as indicated by apoliprotein B. This corresponds to a third of the effect of taking cholesterol-lowering medications such as statins, and would result in a 7% reduction in the risk of cardiovascular disease in someone who maintained a plant-based diet for five years.
“Statin treatment is superior to plant-based diets in reducing fats and cholesterol levels. However, one regimen does not exclude the other, and combining statins with plant-based diets is likely to have a synergistic effect, resulting in an even larger beneficial effect.
“If people start eating vegetarian or vegan diets from an early age, the potential for reducing the risk of cardiovascular disease caused by blocked arteries is substantial. Importantly, we found similar results across continents, ages, different ranges of body mass index, and among people in different states of health.”
Reduced cholesterol levels compared to omnivorous diet
The participants in the 30 studies were randomised to follow either a vegetarian or vegan diet or to continue with an omnivorous diet (which includes meat and dairy products). The length of time on the diets ranged from ten days to five years, with an average of 29 weeks.
Compared to people eating an omnivorous diet, those who were following a plant-based diet experienced an average reduction in total cholesterol levels of 7% from levels measured at the start of the studies, a 10% reduction in LDL cholesterol levels and a 14% reduction in apolipoprotein B levels.
The meta-analysis by Professor Frikke-Schmidt and her colleagues could not assess potential benefits of diets that directly compare fish versus omnivorous diets due to lack of such studies in the scientific literature.
Professor Kevin Maki, of Indiana University School of Public Health Bloomington, and Midwest Biomedical Research, USA, and Professor Carol Kirkpatrick, of Midwest Biomedical Research and Idaho State University, USA, who were not involved in the research, commented in an accompanying editorial: “The results reported by Koch et al add to the body of evidence supporting favourable effects of healthy vegan and vegetarian dietary patterns on circulating levels of LDL-C [LDL cholesterol] and atherogenic lipoproteins, which would be expected to reduce ASCVD [atherosclerotic CVD] risk.
“While it is not necessary to entirely omit foods such as meat, poultry, and fish/seafood to follow a recommended dietary pattern, reducing consumption of such foods is a reasonable option for those who prefer to do so.”