Article

Over the past decade, interest in plant-based diets has grown substantially, driven by evidence linking these dietary patterns to improved cardiometabolic outcomes and reduced environmental impact. This comprehensive review synthesizes research from 2010 to 2025, examining the relationship between plant-based diets and cardiovascular health. Across large prospective cohort studies, greater adherence to plant-based or vegetarian dietary patterns is consistently associated with lower risks of coronary heart disease, stroke, and cardiovascular mortality. Randomized and controlled intervention trials demonstrate favorable effects on key risk factors, including reductions in low-density lipoprotein cholesterol, blood pressure, body weight, and systemic inflammation. Mechanistic investigations attribute these benefits to the high content of dietary fiber, unsaturated fatty acids, antioxidants, and phytochemicals, alongside lower intakes of saturated fat and cholesterol. Additional pathways involve modulation of the gut microbiome, improved endothelial function, and reduced oxidative stress. Despite these advantages, plant-based diets may present nutritional challenges, particularly regarding vitamin B12, iron, calcium, and omega-3 fatty acid adequacy, which require informed dietary planning or supplementation. Current evidence supports the integration of healthful plant-based dietary patterns into cardiovascular disease prevention and management guidelines. However, further research, particularly long-term randomized trials and studies in diverse populations, is needed to strengthen causal inference and optimize implementation strategies. Overall, plant-based diets, when well designed and minimally processed, represent a nutritionally adequate and cardioprotective approach with significant implications for both human and planetary health.