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Perm J. 2015 Winter;19(1):62-7. doi: 10.7812/TPP/14-036. Epub 2014 Nov 24.

A plant-based diet, atherogenesis, and coronary artery disease prevention.

Author information

1
Physician Leader for Total Health in Southern California. phillip.j.tuso@kp.org.
2
Physician for Coordinated Health in Bethlehem, PA. Stollx7@gmail.com.
3
President and Medical Director of the Angiogenesis Foundation of the Institute for Advance Studies in Cambridge, MA. wli@angio.org.

Abstract

A plant-based diet is increasingly becoming recognized as a healthier alternative to a diet laden with meat. Atherosclerosis associated with high dietary intake of meat, fat, and carbohydrates remains the leading cause of mortality in the US. This condition results from progressive damage to the endothelial cells lining the vascular system, including the heart, leading to endothelial dysfunction. In addition to genetic factors associated with endothelial dysfunction, many dietary and other lifestyle factors, such as tobacco use, high meat and fat intake, and oxidative stress, are implicated in atherogenesis. Polyphenols derived from dietary plant intake have protective effects on vascular endothelial cells, possibly as antioxidants that prevent the oxidation of low-density lipoprotein. Recently, metabolites of L-carnitine, such as trimethylamine-N-oxide, that result from ingestion of red meat have been identified as a potential predictive marker of coronary artery disease (CAD). Metabolism of L-carnitine by the intestinal microbiome is associated with atherosclerosis in omnivores but not in vegetarians, supporting CAD benefits of a plant-based diet. Trimethylamine-N-oxide may cause atherosclerosis via macrophage activation. We suggest that a shift toward a plant-based diet may confer protective effects against atherosclerotic CAD by increasing endothelial protective factors in the circulation while reducing factors that are injurious to endothelial cells. The relative ratio of protective factors to injurious endothelial exposure may be a novel approach to assessing an objective dietary benefit from a plant-based diet. This review provides a mechanistic perspective of the evidence for protection by a plant-based diet against atherosclerotic CAD.

PMID:
25431999
PMCID:
PMC4315380
DOI:
10.7812/TPP/14-036
[Indexed for MEDLINE]
Free PMC Article

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