Vegetarians, fish, poultry, and meat-eaters: who has higher risk of cardiovascular disease incidence and mortality? A prospective study from UK Biobank

AIMS: To compare the incidence and mortality risk for cardiovascular diseases (CVD) CVD and also ischaemic heart disease (IHD), myocardial infarction (MI), stroke, and heart failure (HF) among people with different types of diets-including vegetarians, fish eaters, fish and poultry eaters, and meat-eaters-using data from UK Biobank. METHODS AND RESULTS: A total of 422 791 participants (55. 4% women) were included in this prospective analysis. Using data from a food frequency questionnaire, four types of diets were derived. Associations between types of diets and health outcomes were investigated using Cox proportional hazard models. Meat-eaters comprised 94. 7% of the cohort and were more likely to be obese than other diet groups. After a median follow-up of 8. 5 years, fish eaters, compared with meat-eaters, had lower risks of incident CVD hazard ratios (HR): 0. 93 95% confidence intervals (CI): 0. 88-0. 97, IHD HR: 0. 79 (95% CI: 0. 70-0. 88), MI HR: 0. 70 (95% CI: 0. 56-0. 88), stroke HR: 0. 79 (95% CI: 0. 63-0. 98) and HF HR: 0. 78 (95% CI: 0. 63-0. 97), after adjusting for confounders. Vegetarians had lower risk of CVD incidence HR: 0. 91 (95% CI: 0. 86-0. 96) relative to meat-eaters. In contrast, the risk of adverse outcomes was not different in fish and poultry eaters compared with meat-eaters. No associations were identified between types of diets and CVD mortality. CONCLUSION: Eating fish rather than meat or poultry was associated with a lower risk of a range of adverse cardiovascular outcomes. Vegetarianism was only associated with a lower risk of CVD incidence.