Overall and quality-specific plant-based dietary patterns and all-cause mortality in older adults with cardiovascular disease: a prospective cohort study from the CLHLS.

AIMS: To examine the associations of overall plant-based diet index (PDI), healthy plant-based diet index (hPDI), and unhealthy plant-based diet index (uPDI) with all-cause mortality among older Chinese adults with cardiovascular disease using data from the China Longitudinal Healthy Longevity Survey (CLHLS). METHODS AND RESULTS: We analyzed 1,526 participants aged 65 years or older from the 2008 wave of the CLHLS cardiovascular disease population, with mortality follow-up through 2019 (heart disease without stroke: n = 856; cerebrovascular disease without heart disease: n = 480; both: n = 190). Dietary intake was assessed using a food frequency questionnaire and converted into PDI, hPDI, and uPDI. Cox proportional hazards models estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause mortality. The proportional hazards assumption was evaluated using Schoenfeld residuals, and dose-response relationships were examined using restricted cubic splines. CONCLUSION: Among older Chinese adults with cardiovascular disease, greater adherence to an overall plant-based dietary pattern was associated with lower all-cause mortality, whereas greater adherence to an unhealthy plant-based dietary pattern was associated with higher mortality.