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Findings among randomized controlled trials evaluating the effect of red meat on cardiovascular disease risk factors are inconsistent. We provide an updated meta-analysis of randomized controlled trials on red meat and cardiovascular risk factors and determine whether the relationship depends on the composition of the comparison diet, hypothesizing that plant sources would be relatively beneficial. We conducted a systematic PubMed search of randomized controlled trials published up until July 2017 comparing diets with red meat with diets that replaced red meat with a variety of foods. We stratified comparison diets into high-quality plant protein sources (legumes, soy, nuts); chicken/poultry/fish; fish only; poultry only; mixed animal protein sources (including dairy); carbohydrates (low-quality refined grains and simple sugars, such as white bread, pasta, rice, cookies/biscuits); or usual diet. We performed random-effects meta-analyses comparing differences in changes of blood lipids, apolipoproteins, and blood pressure for all studies combined and stratified by specific comparison diets. Thirty-six studies totaling 1803 participants were included. There were no significant differences between red meat and all comparison diets combined for changes in blood concentrations of total, low-density lipoprotein, or high-density lipoprotein cholesterol, apolipoproteins A1 and B, or blood pressure. Relative to the comparison diets combined, red meat resulted in lesser decreases in triglycerides (weighted mean difference [WMD], 0.065 mmol/L; 95% CI, 0.000-0.129; P for heterogeneity <0.01). When analyzed by specific comparison diets, relative to high-quality plant protein sources, red meat yielded lesser decreases in total cholesterol (WMD, 0.264 mmol/L; 95% CI, 0.144-0.383; P<0.001) and low-density lipoprotein (WMD, 0.198 mmol/L; 95% CI, 0.065-0.330; P=0.003). In comparison with fish, red meat yielded greater decreases in low-density lipoprotein (WMD, -0.173 mmol/L; 95% CI, -0.260 to -0.086; P<0.001) and high-density lipoprotein (WMD, -0.065 mmol/L; 95% CI, -0.109 to -0.020; P=0.004). In comparison with carbohydrates, red meat yielded greater decreases in triglycerides (WMD, -0.181 mmol/L; 95% CI, -0.349 to -0.013). Inconsistencies regarding the effects of red meat on cardiovascular disease risk factors are attributable, in part, to the composition of the comparison diet. Substituting red meat with high-quality plant protein sources, but not with fish or low-quality carbohydrates, leads to more favorable changes in blood lipids and lipoproteins.…

PMID: 30958719

This article has been corrected. The original version (PDF) is appended to this article as a Supplement. Dietary guidelines generally recommend limiting intake of red and processed meat. However, the quality of evidence implicating red and processed meat in adverse health outcomes remains unclear. To evaluate the association between red and processed meat consumption and all-cause mortality, cardiometabolic outcomes, quality of life, and satisfaction with diet among adults. EMBASE (Elsevier), Cochrane Central Register of Controlled Trials (Wiley), Web of Science (Clarivate Analytics), CINAHL (EBSCO), and ProQuest from inception until July 2018 and MEDLINE from inception until April 2019, without language restrictions, as well as bibliographies of relevant articles. Cohort studies with at least 1000 participants that reported an association between unprocessed red or processed meat intake and outcomes of interest. Teams of 2 reviewers independently extracted data and assessed risk of bias. One investigator assessed certainty of evidence, and the senior investigator confirmed the assessments. Of 61 articles reporting on 55 cohorts with more than 4 million participants, none addressed quality of life or satisfaction with diet. Low-certainty evidence was found that a reduction in unprocessed red meat intake of 3 servings per week is associated with a very small reduction in risk for cardiovascular mortality, stroke, myocardial infarction (MI), and type 2 diabetes. Likewise, low-certainty evidence was found that a reduction in processed meat intake of 3 servings per week is associated with a very small decrease in risk for all-cause mortality, cardiovascular mortality, stroke, MI, and type 2 diabetes. Inadequate adjustment for known confounders, residual confounding due to observational design, and recall bias associated with dietary measurement. The magnitude of association between red and processed meat consumption and all-cause mortality and adverse cardiometabolic outcomes is very small, and the evidence is of low certainty. None. (PROSPERO: CRD42017074074).…

PMID: 31569213

Associations between red meat consumption and cardio-cerebrovascular diseases (CCVDs) are mostly studied in Western populations but not in Chinese or elderly. This prospective study investigated adults ≥65 years from the China Kadoorie Biobank (CKB). Associations between red meat consumption and CCVD, ischemic stroke/transient ischemic attack (TIA), CCVD mortality, and all-cause mortality were determined by Cox regression. A total of 59,980 participants were analyzed, 14,715 (24.53%) of whom ate red meat daily, 9,843 (16.41%) ate red meat 4-6 days/week, 23,472 (39.13%) ate red meat 1-3 days/week, and 11,950 (19.92%) ate red meat less than 1 day/week. Average amount of red meat usual consumption was 38 g/day. After adjustment, per 50 g/day higher red meat consumption at baseline was significantly associated with increased incident CCVD (aHR = 1.10) among high-income subjects (≥ 10,000 RMB) and urban residents (aHR = 1.12). Per 50 g/day higher baseline red meat consumption was significantly associated with increased ischemic stroke/TIA in urban residents (aHR = 1.08) but decreased risk in rural residents (aHR = 0.84). Higher baseline red meat consumption was associated with lower CCVD mortality in the poorest (aHR = 0.78) and rural residents (aHR = 0.72) and lower all-cause mortality in the poorest (aHR = 0.82) and rural residents (aHR = 0.80). In general, among older adults in China, higher red meat intake independently predicted increased CCVD among urban and high-income individuals but not poor ones. Higher red meat intake appears to be protective against mortality in rural and low-income subjects. Socioeconomic status is a crucial modifying factor on the association between red meat consumption and adverse cardiovascular outcomes in China.…

PMID: 37518346

Background The evidence is equivocal on the association between meat consumption and ischemic heart disease (IHD) risk. To what extent the variation of individuals' metabolic responses to the same diet may account for this association is not fully understood. We aim to identify metabolomic signatures characterizing consumption of unprocessed red meat and processed meat and whether such signatures are associated with IHD risk. Methods and Results We conducted a cohort study of 92 246 individuals (mean age, 56.1 years; 55.1% women) using the UK Biobank. During the median follow-up of 8.74 years, 3059 incident IHD events were documented. Unprocessed red meat and processed meat consumption was assessed using a touchscreen dietary questionnaire. Plasma metabolome was profiled by high-throughput nuclear magnetic resonance spectroscopy. Cox proportional hazards regression model was used to test the association of meat consumption with IHD. Genome-wide association analysis and 1-sample Mendelian randomization were performed for metabolomic signatures and causal association of signatures with IHD. Using elastic net regularized regressions, we constructed metabolomic signatures consisting of 157 and 142 metabolites for unprocessed red meat (Spearman correlation coefficient […

PMID: 36974753

Observational studies show inconsistent associations of red meat consumption with cardiovascular disease (CVD) and diabetes. Moreover, red meat consumption varies by sex and setting, however, whether the associations vary by sex and setting remains unclear. This systematic review and meta-analysis was conducted to summarize the evidence concerning the associations of unprocessed and processed red meat consumption with CVD and its subtypes [coronary heart disease (CHD), stroke, and heart failure], type two diabetes mellitus (T2DM), and gestational diabetes mellitus (GDM) and to assess differences by sex and setting (western vs. eastern, categorized based on dietary pattern and geographic region). Two researchers independently screened studies from PubMed, Web of Science, Embase, and the Cochrane Library for observational studies and randomized controlled trials (RCTs) published by 30 June 2022. Forty-three observational studies (N = 4 462 810, 61.7% women) for CVD and 27 observational studies (N = 1 760 774, 64.4% women) for diabetes were included. Red meat consumption was positively associated with CVD [hazard ratio (HR) 1.11, 95% confidence interval (CI) 1.05 to 1.16 for unprocessed red meat (per 100 g/day increment); 1.26, 95% CI 1.18 to 1.35 for processed red meat (per 50 g/day increment)], CVD subtypes, T2DM, and GDM. The associations with stroke and T2DM were higher in western settings, with no difference by sex. Unprocessed and processed red meat consumption are both associated with higher risk of CVD, CVD subtypes, and diabetes, with a stronger association in western settings but no sex difference. Better understanding of the mechanisms is needed to facilitate improving cardiometabolic and planetary health.…

PMID: 37264855

The role of red meat in cardiovascular risk remains controversial. The aim of this systematic review and Bayesian network meta-analysis (NMA) of randomized controlled trials (RCTs) was to investigate the effects of red meat consumption on cardiovascular risk factors concerning different comparison foods. A systematic search of RCTs was conducted from the inception to April 2024. Studies compared diets containing red meat to those replacing red meat with various foods. Comparison diets were classified into high-quality plant protein sources, animal protein, mixed animal and plant protein and carbohydrates. The effects of the dietary interventions on cardiovascular parameters were evaluated using a random-effects NMA, with an analysis of interactions between the intervention and control groups. The outcomes were the mean changes in blood lipids, blood pressure, and C-reactive protein (CRP) in the red meat group compared to the comparator group. Thirty-six RCTs were included in the analysis. Consuming plant proteins resulted in a greater reduction in total cholesterol (TC) levels (mean difference (MD) = -0.14; 95 % credible interval (CrI): -0.28 to -0.001, p < 0.05) and low-density lipoprotein cholesterol (LDL-C) levels (MD = -0.19; 95 % CrI: -0.36 to -0.03, p < 0.05) compared to red meat interventions. In contrast, interventions combining animal and plant proteins increased TG levels more than red meat interventions (MD = 0.21; 95 % CrI: 0.06 to 0.34, p < 0.05). The certainty of the evidence for all outcomes ranged from very low to low. The findings of this NMA indicate that the effect of red meat on cardiovascular risk factors depends on the comparison food. Replacing red meat with plant protein sources was associated with favorable changes in TC levels and LDL-C. REGISTRY AND REGISTRY NUMBER FOR SYSTEMATIC REVIEWS OR META-ANALYSES: CRD42024537865 https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024537865.…

PMID: 40997609

Despite data suggesting that apolipoprotein B (apoB) measurement outperforms low-density lipoprotein cholesterol level measurement in predicting atherosclerotic cardiovascular disease risk, apoB measurement has not become widely adopted into routine clinical practice. One barrier for use of apoB measurement is lack of consistent guidance for clinicians on how to interpret and apply apoB results in clinical context. Whereas guidelines have often provided clear low-density lipoprotein cholesterol targets or triggers to initiate treatment change, consistent targets for apoB are lacking. In this review, we synthesize existing data regarding the epidemiology of apoB by comparing guideline recommendations regarding use of apoB measurement, describing population percentiles of apoB relative to low-density lipoprotein cholesterol levels, summarizing studies of discordance between low-density lipoprotein cholesterol and apoB levels, and evaluating apoB levels in clinical trials of lipid-lowering therapy to guide potential treatment targets. We propose evidence-guided apoB thresholds for use in cholesterol management and clinical care.…

PMID: 38950110

Prolonged or excessive exposure to oxidized phospholipids (OxPLs) generates chronic inflammation. OxPLs are present in atherosclerotic lesions and can be detected in plasma on apolipoprotein B (apoB)-containing lipoproteins. When initially conceptualized, OxPL-apoB measurement in plasma was expected to reflect the concentration of minimally oxidized LDL, but, surprisingly, it correlated more strongly with plasma lipoprotein(a) (Lp(a)) levels. Indeed, experimental and clinical studies show that Lp(a) particles carry the largest fraction of OxPLs among apoB-containing lipoproteins. Plasma OxPL-apoB levels provide diagnostic information on the presence and extent of atherosclerosis and improve the prognostication of peripheral artery disease and first and recurrent myocardial infarction and stroke. The addition of OxPL-apoB measurements to traditional cardiovascular risk factors improves risk reclassification, particularly in patients in intermediate risk categories, for whom improving decision-making is most impactful. Moreover, plasma OxPL-apoB levels predict cardiovascular events with similar or greater accuracy than plasma Lp(a) levels, probably because this measurement reflects both the genetics of elevated Lp(a) levels and the generalized or localized oxidation that modifies apoB-containing lipoproteins and leads to inflammation. Plasma OxPL-apoB levels are reduced by Lp(a)-lowering therapy with antisense oligonucleotides and by lipoprotein apheresis, niacin therapy and bariatric surgery. In this Review, we discuss the role of role OxPLs in the pathophysiology of atherosclerosis and Lp(a) atherogenicity, and the use of OxPL-apoB measurement for improving prognosis, risk reclassification and therapeutic interventions.…

PMID: 37848630

Mycoprotein is a relatively novel food source produced from the biomass of Fusarium venenatum. It has previously been shown to improve CVD risk markers in intervention trials when it is compared against total meat. It has not hitherto been assessed specifically for benefits relative to red and processed meat. We leveraged samples from Mycomeat, an investigator-blind randomised crossover controlled trial in metabolically healthy male adults (n = 20), randomised to consume 240 g/day of red and processed meat for 14 days followed by mycoprotein, or vice versa. Blood biochemical indices were a priori defined secondary endpoints. Mycoprotein consumption led to a 6.74% reduction in total cholesterol (P = 0.02) and 12.3% reduction in LDL cholesterol (P = 0.02) from baseline values. Change in fasted triglycerides was not significantly different between diets (+ 0.19 ± 0.11 mmol/l with mycoprotein, P = 0.09). There was a small but significant reduction in waist circumference for mycoprotein relative to meat (- 0.95 ± 0.42 cm, P = 0.04). Following the mycoprotein diet, mean systolic (- 2.41 ± 1.89 mmHg, P = 0.23) and diastolic blood pressure (- 0.80 ± 1.23 mmHg, P = 0.43) were reduced from baseline. There were no statistically significant effects of the intervention on urinary sodium, nitrite or TMAO; while urinary potassium (+ 126.12 ± 50.30 mmol/l, P = 0.02) and nitrate (+ 2.12 ± 0.90 mmol/l, P = 0.04) were both significantly higher with mycoprotein relative to meat. The study population comprised metabolically healthy adults, therefore, changes in plasma lipids had little effect on cardiovascular risk scores (- 0.34% FRS for mycoprotein P = 0.24). These results confirm potential cardiovascular benefits when displacing red and processed meat with mycoprotein in the diet. Longer trials in higher risk study populations are needed to fully elucidate suggested benefits for blood pressure and body composition. gov Identifier: NCT03944421.…

PMID: 37624376

Legumes are recommended as a sustainable alternative protein source to red and processed meat (RPM). We studied the effects of a partial substitution of RPM with non-soy legumes on nutrient intakes and status, anthropometric measurements, and biomarkers of cardiovascular diseases and type 2 diabetes risk in healthy working-age men. In a 6-week clinical trial, 102 men (mean age 38 years, range 21-61) were randomized to either the MEAT group, consuming 760 g/week of RPM (25% of total protein intake (TPI)) or the LEGUME group, consuming 200 g/week of RPM corresponding to the maximum of the Planetary Health Diet (5% of TPI) along with legume-based foods containing protein equivalent to 560 g/week of red meat (20% of TPI). TPI target was 18 E%. Four-day food records, blood, and 24-h urine samples were collected at baseline and endpoint. At the endpoint, the LEGUME group had higher intakes of fiber (g/MJ, P = 0.006), polyunsaturated fatty acids (E%, P < 0.001), and iron (mg/MJ, P < 0.001) compared to the MEAT group, but lower intakes of saturated fatty acids (E%, P = 0.012) and vitamin B12 (µg/MJ, P < 0.001). The LEGUME group had lower vitamin B12 status (holotranscobalamin, P = 0.022), iodine status (24-h urinary iodine excretion, P = 0.041), total and LDL cholesterol (both P < 0.001), and BMI and weight (both P = 0.009). Implementing a moderate dietary shift by consuming more legumes and less RPM may beneficially affect biomarkers of cardiovascular diseases and weight in healthy working-age men while maintaining nutritional adequacy of iodine, iron, and vitamin B12 in the short term. Trial Registration Clinical trial registration ClinicalTrials.gov as NCT04599920 in October 2020.…

PMID: 40828321

What we eat is a cornerstone of cardiovascular disease (CVD) prevention, but health professionals may not have a clear understanding of the current evidence-based research to underpin eating habits and recommendations. This study aims to appraise existing evidence-based research on the importance of diet on CVD risk biomarkers, specifically, the effects of dietary patterns, specific foods, and constituents including vitamins/minerals and plant-derived bioactive compounds on CVD risk. Plant-based dietary patterns rich in minimally processed foods, vegetables, and fruits reduce CVD risk, while patterns rich in ultra-processed foods, meat, salt, sugar, and saturated fat increase risk. The Mediterranean, Dietary Approaches to Stop Hypertension, and vegetarian diets reduce CVD risk, while vegan diets offer no additional benefit. Low-carbohydrate diets may be beneficial, but their long-term effect remains to be confirmed. Balanced distribution of caloric intake through different meals is associated with favourable effects. Fasting (e.g. alternate-day, intermittent, time-restricted, and periodic) can reduce CVD risk but is often challenging. Moderate coffee consumption is not associated with increased risk of CVD. The consumption of one unit of alcohol/day may contribute to a reduced cardiovascular risk without presenting an unfavourable risk profile. Generally, there is no evidence that vitamin and mineral supplementation reduces CVD risk. High potassium intake is beneficial in healthy individuals, calcium or selenium supplementation shows no added benefit, and high sodium intake is detrimental. Diet is a major component of CVD prevention, and health professionals should include dietary assessment and evidence-based recommendations in their clinical practice.…

PMID: 40504596

Previous research suggests detrimental health effects associated with consuming processed foods, including processed meats, sugar-sweetened beverages (SSBs) and trans fatty acids (TFAs). However, systematic characterization of the dose-response relationships between these foods and health outcomes is limited. Here, using Burden of Proof meta-regression methods, we evaluated the associations between processed meat, SSBs and TFAs and three chronic diseases: type 2 diabetes, ischemic heart disease (IHD) and colorectal cancer. We conservatively estimated that-relative to zero consumption-consuming processed meat (at 0.6-57 g d…

PMID: 40588677