Effects of a Vegetarian Diet on Cardiometabolic Risk Factors, Gut Microbiota, and Plasma Metabolome in Subjects With Ischemic Heart Disease: A Randomized, Crossover Study
Journal article, 2020

Background A vegetarian diet (VD) may reduce future cardiovascular risk in patients with ischemic heart disease. Methods and Results A randomized crossover study was conducted in subjects with ischemic heart disease, assigned to 4-week intervention periods of isocaloric VD and meat diet (MD) with individually designed diet plans, separated by a 4-week washout period. The primary outcome was difference in oxidized low-density lipoprotein cholesterol (LDL-C) between diets. Secondary outcomes were differences in cardiometabolic risk factors, quality of life, gut microbiota, fecal short-chain and branched-chain fatty acids, and plasma metabolome. Of 150 eligible patients, 31 (21%) agreed to participate, and 27 (87%) participants completed the study. Mean oxidized LDL-C (-2.73 U/L), total cholesterol (-5.03 mg/dL), LDL-C (-3.87 mg/dL), and body weight (-0.67 kg) were significantly lower with the VD than with the MD. Differences between VD and MD were observed in the relative abundance of several microbe genera within the families Ruminococcaceae, Lachnospiraceae, and Akkermansiaceae. Plasma metabolites, including l-carnitine, acylcarnitine metabolites, and phospholipids, differed in subjects consuming VD and MD. The effect on oxidized LDL-C in response to the VD was associated with a baseline gut microbiota composition dominated by several genera of Ruminococcaceae. Conclusions The VD in conjunction with optimal medical therapy reduced levels of oxidized LDL-C, improved cardiometabolic risk factors, and altered the relative abundance of gut microbes and plasma metabolites in patients with ischemic heart disease. Our results suggest that composition of the gut microbiota at baseline may be related to the reduction of oxidized LDL-C observed with the VD. Registration URL: https://www.clini​caltr​ials.gov; Unique identifier: NCT02942628.

gut microbiota

coronary artery disease

trimethylamine N-oxide

vegetarian diet

plasma metabolome

randomized controlled trial


Demir Djekic

Örebro läns landsting

Lin Shi

Shaanxi Normal University

Chalmers, Biology and Biological Engineering, Food and Nutrition Science

Harald Brolin

Wallenberg Lab.

Frida Carlsson

Chalmers, Biology and Biological Engineering, Food and Nutrition Science

Charlotte Särnqvist

Örebro läns landsting

Otto Savolainen

Chalmers, Biology and Biological Engineering, Systems and Synthetic Biology

Yang Cao

Örebro University

Fredrik Bäckhed

University of Copenhagen

Sahlgrenska University Hospital

Wallenberg Lab.

Valentina Tremaroli

Wallenberg Lab.

Rikard Landberg

Chalmers, Biology and Biological Engineering, Food and Nutrition Science

Umeå University

Ole Fröbert

Örebro läns landsting

Journal of the American Heart Association

20479980 (eISSN)

Vol. 9 18 e016518-e016518

Subject Categories

Other Clinical Medicine

General Practice

Nutrition and Dietetics





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