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Healthful plant-based dietary patterns, PM2·5 exposure and the risk of heart failure: a population-based cohort study

Published online by Cambridge University Press:  04 April 2025

Shenshen Zhu ,
Xiaoqing Zhang ,
Zhaoke Wu ,
Yuefei Jin ,
Weidong Wu ,
Junxi Zhang ,
Xiaolong Zhang ,
Yacong Bo ,
Yongjian Zhu Open the ORCID record for Yongjian Zhu [Opens in a new window]  and
Ling Li Open the ORCID record for Ling Li [Opens in a new window]
Shenshen Zhu
Affiliation:
Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, People’s Republic of China
Xiaoqing Zhang
Affiliation:
School of Public Health, Zhengzhou University, Zhengzhou 450001, People’s Republic of China
Zhaoke Wu
Affiliation:
Department of Gerontology, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou 450014, People’s Republic of China
Yuefei Jin
Affiliation:
School of Public Health, Zhengzhou University, Zhengzhou 450001, People’s Republic of China
Weidong Wu
Affiliation:
School of Public Health, Xinxiang Medical University, Xinxiang 453003, People’s Republic of China
Junxi Zhang
Affiliation:
NHC Key Laboratory of Birth Defects Prevention & Henan Key Laboratory of Population Defects Prevention, Zhengzhou, People’s Republic of China
Xiaolong Zhang
Affiliation:
NHC Key Laboratory of Birth Defects Prevention & Henan Key Laboratory of Population Defects Prevention, Zhengzhou, People’s Republic of China
Yacong Bo
Affiliation:
School of Public Health, Zhengzhou University, Zhengzhou 450001, People’s Republic of China NHC Key Laboratory of Birth Defects Prevention & Henan Key Laboratory of Population Defects Prevention, Zhengzhou, People’s Republic of China
Yongjian Zhu*
Affiliation:
Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, People’s Republic of China NHC Key Laboratory of Birth Defects Prevention & Henan Key Laboratory of Population Defects Prevention, Zhengzhou, People’s Republic of China
Ling Li*
Affiliation:
Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, People’s Republic of China
*
Corresponding authors: Ling Li; Email: [email protected], Yongjian Zhu; Email: [email protected]
Corresponding authors: Ling Li; Email: [email protected], Yongjian Zhu; Email: [email protected]
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Abstract

Fine particulate matter (PM2·5) is a known risk factor for heart failure (HF), while plant-based dietary patterns may help reduce HF risk. This study examined the combined impact of PM2·5 exposure and a plant-based diet on HF incidence. A total of 190 092 participants from the UK Biobank were included in this study. HF cases were identified through linkage to the UK National Health Services register, with follow-up lasting until October 2022 in England, August 2022 in Scotland and May 2022 in Wales. Annual mean PM2·5 concentration was obtained using a land use regression model, while the healthful plant-based diet index (hPDI) was calculated using the Oxford WebQ tool based on two or more 24-hour dietary assessments of seventeen major food groups. Cox proportional hazard models assessed the associations of PM2·5 and hPDI with HF risk, and interactions were evaluated on additive and multiplicative scales. During a median of 13·4-year follow-up, 4351 HF cases were recorded. Participants in the highest PM2·5 tertile had a 23 % increased HF risk (hazard ratio: 1·23, 95 % CI: 1·14, 1·32) compared with those in the lowest tertile. Moderate or high hPDI was associated with reduced HF risk relative to low hPDI. The lowest HF risk was observed in individuals with high hPDI and low PM2·5 exposure, underscoring the protective role of a plant-based diet, particularly in areas with lower PM2·5 levels. A healthy plant-based diet may mitigate HF risk, especially in populations exposed to lower PM2·5 levels.

Keywords

Healthful plant-based dietary patternsPM2·5Heart failureCohort study
Type
Research Article
Information
British Journal of Nutrition , First View , pp. 1 - 6
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Copyright
© The Author(s), 2025. Published by Cambridge University Press on behalf of The Nutrition Society

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References

Yan, T, Zhu, S, Yin, X, et al. (2023) Burden, trends, and inequalities of heart failure globally, 1990 to 2019: a secondary analysis based on the Global Burden of Disease 2019 study. J Am Heart Assoc 12, e027852.Google Scholar
Vogli, M, Peters, A, Wolf, K, et al. (2024) Long-term exposure to ambient air pollution and inflammatory response in the KORA study. Sci Total Environ 912, 169416.Google Scholar
Lim, CC, Hayes, RB, Ahn, J, et al. (2019) Mediterranean diet and the association between air pollution and cardiovascular disease mortality risk. Circulation 139, 1766–1775.Google Scholar
Tong, H (2016) Dietary and pharmacological intervention to mitigate the cardiopulmonary effects of air pollution toxicity. BBA 1860, 2891–2898.Google Scholar
Tong, H, Rappold, AG, Caughey, M, et al. (2015) Dietary supplementation with olive oil or fish oil and vascular effects of concentrated ambient particulate matter exposure in human volunteers. Environ Health Perspect 123, 1173–1179.Google Scholar
Aleksandrova, K, Koelman, L & Rodrigues, CE (2021) Dietary patterns and biomarkers of oxidative stress and inflammation: a systematic review of observational and intervention studies. Redox Biol 42, 101869.Google Scholar
Liang, F, Fu, J, Turner-McGrievy, G, et al. (2022) Association of Body Mass Index and Plant-Based diet with cognitive impairment among older Chinese adults: a prospective, nationwide cohort study. Nutrients 14, 3132.Google Scholar
Díez, J & Butler, J (2023) Growing heart failure burden of hypertensive heart disease: a call to action. Hypertension 80, 13–21.Google Scholar
Baden, MY, Liu, G, Satija, A, et al. (2019) Changes in plant-based diet quality and total and cause-specific mortality. Circulation 140, 979–991.Google Scholar
Sudlow, C, Gallacher, J, Allen, N, et al. (2015) UK Biobank: an open access resource for identifying the causes of a wide range of complex diseases of middle and old age. PLoS Med 12, e1001779.Google Scholar
Ho, FK, Zhou, Z, Petermann-Rocha, F, et al. (2022) Association between device-measured physical activity and incident heart failure: a prospective cohort study of 94 739 UK Biobank participants. Circulation 146, 883–891.Google Scholar
Liang, YY, Chen, Y, Feng, H, et al. (2023) Association of social isolation and loneliness with incident heart failure in a population-based cohort study. JACC Heart Fail 11, 334–344.Google Scholar
Heianza, Y, Zhou, T, Sun, D, et al. (2021) Healthful plant-based dietary patterns, genetic risk of obesity, and cardiovascular risk in the UK Biobank study. Clin Nutr (Edinburgh, Scotland) 40, 4694–4701.Google Scholar
Satija, A, Bhupathiraju, SN, Spiegelman, D, et al. (2017) Healthful and unhealthful plant-based diets and the risk of coronary heart disease in U.S. adults. J Am Coll Cardiol 70, 411–422.Google Scholar
Bradbury, KE, Young, HJ, Guo, W, et al. (2018) Dietary assessment in UK Biobank: an evaluation of the performance of the touchscreen dietary questionnaire. J Nutr Sci 7, e6.Google Scholar
Wang, M, Zhou, T, Song, Y, et al. (2021) Joint exposure to various ambient air pollutants and incident heart failure: a prospective analysis in UK Biobank. Eur Heart J 42, 1582–1591.Google Scholar
Gao, X, Huang, N, Guo, X, et al. (2022) Role of sleep quality in the acceleration of biological aging and its potential for preventive interaction on air pollution insults: findings from the UK Biobank cohort. Aging Cell 21, e13610.Google Scholar
Thompson, AS, Candussi, CJ, Tresserra-Rimbau, A, et al. (2024) A healthful plant-based diet is associated with lower type 2 diabetes risk via improved metabolic state and organ function: a prospective cohort study. Diabetes Metab 50, 101499.Google Scholar
Zhu, F, Qi, H, Bos, M, et al. (2023) Female reproductive factors and risk of new-onset heart failure: findings from UK Biobank. JACC Heart Fail 11, 1203–1212.Google Scholar
Lu, Y, Xu, Z, Georgakis, MK, et al. (2021) Smoking and heart failure: a Mendelian randomization and mediation analysis. ESC Heart Fail 8, 1954–1965.Google Scholar
Larsson, SC, Burgess, S, Mason, AM, et al. (2020) Alcohol consumption and cardiovascular disease: a Mendelian randomization study. Circ Genom Precis Med 13, e002814.Google Scholar
Larsson, SC, Tektonidis, TG, Gigante, B, et al. (2016) Healthy lifestyle and risk of heart failure: results from 2 prospective cohort studies. Circ Heart Fail 9, e002855.Google Scholar
Craig, WJ, Mangels, AR, Fresán, U, et al. (2021) The safe and effective use of plant-based diets with guidelines for health professionals. Nutrients 13, 4144.Google Scholar
Wastyk, HC, Fragiadakis, GK, Perelman, D, et al. (2021) Gut-microbiota-targeted diets modulate human immune status. Cell 184, 4137–4153.e4114.Google Scholar
Ketnawa, S, Reginio, FC Jr, Thuengtung, S, et al. (2022) Changes in bioactive compounds and antioxidant activity of plant-based foods by gastrointestinal digestion: a review. Crit Rev Food Sci Nutr 62, 4684–4705.Google Scholar
Sanders-van Wijk, S, Tromp, J, Beussink-Nelson, L, et al. (2020) Proteomic evaluation of the comorbidity-inflammation paradigm in heart failure with preserved ejection fraction: results from the PROMIS-HFpEF study. Circulation 142, 2029–2044.Google Scholar
Murphy, SP, Kakkar, R, McCarthy, CP, et al. (2020) Inflammation in heart failure: JACC state-of-the-art review. J Am Coll Cardiol 75, 1324–1340.Google Scholar
Lau, ES, Roshandelpoor, A, Zarbafian, S, et al. (2023) Eicosanoid and eicosanoid-related inflammatory mediators and exercise intolerance in heart failure with preserved ejection fraction. Nat Commun 14, 7557.Google Scholar
Kumar, P, Lim, A, Poh, SL, et al. (2022) Pro-inflammatory derangement of the immuno-interactome in heart failure. Front Immunol 13, 817514.Google Scholar
Richter, CK, Skulas-Ray, AC, Champagne, CM, et al. (2015) Plant protein and animal proteins: do they differentially affect cardiovascular disease risk? Adv Nutr (Bethesda, Md) 6, 712–728.Google Scholar
Zhang, D, Chen, W, Cheng, C, et al. (2023) Air pollution exposure and heart failure: a systematic review and meta-analysis. Sci Total Environ 872, 162191.Google Scholar
Jia, Y, Lin, Z, He, Z, et al. (2023) Effect of air pollution on heart failure: systematic review and meta-analysis. Environ Health Perspect 131, 76001.Google Scholar
Rajagopalan, S, Al-Kindi, SG & Brook, RD (2018) Air pollution and cardiovascular disease: JACC state-of-the-art review. J Am Coll Cardiol 72, 2054–2070.Google Scholar
Bai, L, Shin, S, Burnett, RT, et al. (2019) Exposure to ambient air pollution and the incidence of congestive heart failure and acute myocardial infarction: a population-based study of 5·1 million Canadian adults living in Ontario. Environ Int 132, 105004.Google Scholar
Hu, X, Nie, Z, Ou, Y, et al. (2023) Long-term exposure to ambient air pollution, circadian syndrome and cardiovascular disease: a nationwide study in China. Sci Total Environ 868, 161696.Google Scholar
Tian, F, Cai, M, Li, H, et al. (2022) Air pollution associated with incident stroke, poststroke cardiovascular events, and death: a trajectory analysis of a prospective cohort. Neurology 99, e2474–e2484.Google Scholar
Wang, X, Ran, S, Xia, H, et al. (2023) Ambient air pollution associated with incident asthma, subsequent cardiovascular disease and death: a trajectory analysis of a national cohort. J Hazard Mater 460, 132372.Google Scholar
Hayes, RB, Lim, C, Zhang, Y, et al. (2020) PM2·5 air pollution and cause-specific cardiovascular disease mortality. Int J Epidemiol 49, 25–35.Google Scholar
Zhang, S, Qian, ZM, Chen, L, et al. (2023) Exposure to air pollution during pre-hypertension and subsequent hypertension, cardiovascular disease, and death: a trajectory analysis of the UK Biobank Cohort. Environ Health Perspect 131, 17008.Google Scholar
de Mutsert, R, de Jager, DJ, Jager, KJ, et al. (2011) Interaction on an additive scale. Nephron Clin Pract 119, c154–157.Google Scholar
Knol, MJ & VanderWeele, TJ (2012) Recommendations for presenting analyses of effect modification and interaction. Int J Epidemiol 41, 514–520.Google Scholar
Satija, A, Bhupathiraju, SN, Rimm, EB, et al. (2016) Plant-based dietary patterns and incidence of type 2 diabetes in US men and women: results from three prospective cohort studies. PLoS Med 13, e1002039.Google Scholar
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