Vegan vs. Non-Vegan Diet : Cardiometabolic Disease Evidence Review
New 2023-2025 research: Does a vegan diet prevent heart disease and diabetes? Comprehensive review of plant-based benefits, gut-microbiome links, and required B12 steps.
NUTRITION
Dr. T.S. Didwal, M.D.
12/12/20259 min read
The relationship between dietary patterns and cardiometabolic health has become one of the most researched areas in modern nutrition science. As global rates of cardiovascular disease and type 2 diabetes continue to rise, consumers and healthcare professionals alike are searching for dietary interventions that truly work. Among the most debated approaches are vegan diets and vegetarian diets, which have gained significant popularity alongside traditional omnivorous diets in recent years.
But what does the latest science actually tell us? Does eliminating animal products genuinely reduce your risk of cardiometabolic disease, or is the relationship more nuanced? Recent research offers compelling insights into the impact of plant-based diets and traditional meat-containing diets on heart health, metabolic markers, and long-term disease prevention.
This comprehensive guide explores cutting-edge research on vegan diets, vegetarian diets, and their impact on cardiometabolic disease risk, while examining the mechanisms, benefits, and potential drawbacks of each approach.
Clinical Pearls
Cardiovascular Risk Reduction is Quantifiable: Plant-based diets are consistently associated with a specific, significant reduction in cardiovascular disease (CVD) risk, estimated at approximately 25%-30% compared to omnivorous diets. (Agnoli et al., 2023)
The Gut-Heart Axis is a Key Mechanism: Beyond traditional nutrient intake, the benefits of plant-based diets are mediated by the gut microbiome. Adherence to plant-based diets shifts microbial profiles to increase butyrate-producing bacteria, which correlates with improved glucose metabolism and reduced cardiometabolic inflammation. (Asnicar et al., 2025)
Benefits are Dose-Dependent and Longitudinal: Cardiometabolic improvements (e.g., in LDL cholesterol, systolic blood pressure, and insulin sensitivity) are directly related to adherence. Individuals consuming>75% plant foods demonstrate greater and more rapid improvements within 6–12 months than those with partial adherence. (Wang et al., 2025)
B12 Supplementation is Mandatory, Not Optional, in Vegan Diets: The most critical nutritional safeguard for a fully plant-based (vegan) diet is mandatory Vitamin B12 supplementation to prevent deficiency risks, though careful attention must also be paid to iron bioavailability (enhanced by Vitamin C co-consumption) and calcium intake. (Wang et al., 2023)
Focus on Whole Foods to Maximize Efficacy: The protective effects are maximized by high-quality, whole-food plant-based diets. Vegan diets based on processed plant-based meats and refined carbohydrates may lose significant cardiometabolic benefits compared to those emphasizing whole grains, legumes, fruits, and vegetables. (Wang et al., 2023)
Vegan vs Non-Vegan Diets and Cardiometabolic Disease
Understanding Cardiometabolic Disease
Before diving into dietary comparisons, let's clarify what we mean by cardiometabolic disease. This term encompasses a cluster of conditions affecting both cardiovascular health and metabolic function, including heart disease, stroke, hypertension, and metabolic syndrome. These conditions often share common risk factors like inflammation, insulin resistance, dyslipidemia (abnormal blood lipids), and obesity.
The prevalence of cardiometabolic disease makes prevention through diet especially critical. This is where dietary intervention research becomes invaluable.
The Case for Plant-Based Diets: What Recent Research Shows
Study 1: The Comprehensive Health Benefits of Vegetarian Diets
Agnoli and colleagues (2023) conducted an extensive systematic review examining the health effects of vegetarian diets published in Nutrition, Metabolism, and Cardiovascular Diseases. This landmark analysis synthesized evidence from numerous studies to assess whether vegetarian diet adherence truly prevents chronic disease (Agnoli et al., 2023).
Key Findings:
Vegetarian diets were associated with reduced risk of cardiovascular disease by approximately 25–30%
Reduced hypertension risk by 8–13% compared to omnivorous diets
Improved lipid profiles, particularly lower LDL cholesterol and triglycerides
Better glycemic control and lower type 2 diabetes incidence
Potential for weight management and reduced obesity risk
Key Takeaway: The research supports that plant-based diet adoption demonstrates consistent protective effects against multiple cardiometabolic disease risk factors (Agnoli et al., 2023). These benefits appear to stem from higher fiber intake, lower saturated fat consumption, and increased micronutrient density in vegetarian diets.
Study 2: Gut Microbiota and Cardiometabolic Health
Asnicar and colleagues (2025) conducted groundbreaking research exploring the relationship between gut microorganisms, dietary patterns, and cardiometabolic health in Nature (Asnicar et al., 2025). This study emphasizes an often-overlooked mechanism: how plant-based diet consumption reshapes your gut microbiome composition.
Study Overview: The researchers examined associations between specific bacterial taxa and various nutritional and dietary interventions, including vegan diets and vegetarian diets, investigating how these patterns affect cardiometabolic markers.
Key Findings:
Plant-based diet followers exhibited distinct microbiome profiles characterized by increased butyrate-producing bacteria
These bacterial communities correlated with improved glucose metabolism and reduced cardiometabolic inflammation
Dietary interventions emphasizing plant foods produced favorable shifts in microbial diversity within weeks
The gut-heart axis appears to be a critical mechanism linking dietary pattern choices to cardiovascular outcomes
Key Takeaway: Beyond direct nutritional composition, vegan and vegetarian diets may benefit cardiometabolic health through beneficial alterations of the gut microbiome (Asnicar et al., 2025), promoting bacterial species that produce protective metabolites like butyrate. This represents an important mechanism explaining why plant-based dietary patterns show cardiovascular benefits.
Study 3: Plant-Based Diets and Long-Term Cardiometabolic Markers
Wang and colleagues (2025) published a longitudinal analysis in the American Journal of Clinical Nutrition examining how plant-based diet adherence relates to cardiometabolic marker changes over time (Wang et al., 2025).
Study Design: This population-based cohort study tracked cardiometabolic parameters including LDL cholesterol, blood pressure, blood glucose, and body mass index in participants with varying degrees of plant-based diet adherence.
Key Findings:
Greater adherence to plant-based diets predicted larger decreases in LDL cholesterol and systolic blood pressure
Participants maintaining high plant-based diet adherence showed improved insulin sensitivity over the follow-up period
The benefits appeared dose-dependent: individuals consuming >75% plant foods showed greater improvements than those with partial plant-based diet adoption
These improvements emerged within 6–12 months of dietary intervention, suggesting relatively rapid cardiometabolic benefits
Key Takeaway: Adherence to plant-based diets demonstrates longitudinal benefits for cardiometabolic markers in real-world populations (Wang et al., 2025). The degree of dietary adherence—how strictly individuals follow plant-based eating patterns—appears crucial for maximizing cardiovascular disease prevention.
Study 4: Cardiovascular and Environmental Considerations
Peruvemba and colleagues (2025) examined diets beneficial for both cardiovascular health and planetary sustainability in their scoping review published in Current Atherosclerosis Reports (Peruvemba et al., 2025). This research recognizes that dietary recommendations must consider both cardiometabolic disease prevention and environmental impact.
Key Findings:
Plant-based dietary patterns consistently showed cardiometabolic benefits while also reducing environmental footprint
Vegetarian and vegan diets substantially lowered greenhouse gas emissions compared to meat-heavy diets
Even flexitarian approaches (predominantly plant-based with occasional animal products) provided meaningful cardiometabolic benefits and improved sustainability
A Mediterranean-style vegetarian diet offered optimal balance between health outcomes and practical adoption
Key Takeaway: The evidence supports that dietary patterns most beneficial for cardiometabolic health align with those most beneficial for the planet (Peruvemba et al., 2025). This dual benefit strengthens the case for plant-based diet adoption from both personal health and global perspectives.
Examining Potential Drawbacks: A Balanced Perspective
Study 5: Benefits and Drawbacks of Vegetarian and Vegan Diets
Wang and colleagues (2023) published a comprehensive review in the European Heart Journal providing nuanced analysis of both benefits and potential concerns with vegetarian and vegan diets.
Benefits Confirmed:
Reduced cardiovascular disease risk
Lower hypertension prevalence
Improved lipid profiles and inflammatory markers
Better weight management
Reduced type 2 diabetes risk
Potential Drawbacks Identified:
Vitamin B12 deficiency risk requires supplementation in vegan diets
Iron bioavailability concerns, though absorption can be enhanced through vitamin C co-consumption
Protein adequacy demands careful planning to achieve sufficient amino acid profiles
Higher sodium intake possible if processed plant-based foods dominate
Calcium intake requires attention to fortified foods or supplements in vegan diets
Some individuals report nutrient deficiencies without proper dietary planning
Key Takeaway: While plant-based diets offer substantial cardiometabolic benefits, successful implementation requires nutritional knowledge. Individuals following vegan diets should prioritize vitamin B12 supplementation, ensure adequate plant-based protein sources, and monitor key micronutrient intake to avoid deficiency.
Key Differences Between Vegetarian and Vegan Approaches
The research distinguishes between approaches:
Vegetarian Diets eliminate meat but typically include dairy and eggs, reducing the risk of nutrient deficiencies while maintaining cardiometabolic benefits.
Vegan Diets eliminate all animal products, maximizing potential cardiovascular benefits but requiring more vigilant nutritional supplementation and dietary planning.
Omnivorous Diets including moderate meat consumption can support cardiometabolic health if structured appropriately with emphasis on whole grains, vegetables, fruits, and lean proteins while limiting processed foods.
Mechanisms: How Plant-Based Diets Reduce Cardiometabolic Disease Risk
The research identifies several biological mechanisms:
Improved Lipid Profiles: Reduced LDL cholesterol and triglycerides from lower saturated fat intake
Enhanced Insulin Sensitivity: Dietary fiber and whole plant-based foods improve glucose metabolism and reduce insulin resistance
Reduced Inflammation: Plant-based diets contain abundant phytonutrients and antioxidants that suppress chronic inflammation
Microbiome Optimization: Fiber-rich diets promote beneficial bacterial communities producing cardioprotective metabolites
Improved Blood Pressure: Plant-based diets are naturally lower in sodium and higher in potassium, supporting blood pressure regulation
Healthy Weight Management: Plant-based foods offer satiety with fewer calories, supporting obesity prevention
Practical Considerations for Different Dietary Choices
Optimizing Plant-Based Diets
Ensure adequate plant-based protein sources (legumes, nuts, seeds, whole grains)
Supplement with vitamin B12
Combine plant foods with vitamin C sources to enhance iron absorption
Choose whole foods over processed meat substitutes
Monitor calcium and iodine intake
Optimizing Omnivorous Diets for Cardiometabolic Health
Emphasize lean protein sources (poultry, fish)
Limit processed meat consumption
Include abundant vegetables, fruits, and whole grains
Choose healthy fats (olive oil, nuts, fish)
Reduce added sugars and refined carbohydrates
Flexitarian Approach
Adopt predominantly plant-based eating with occasional animal products
Combines cardiometabolic benefits of plant-based diets with practical flexibility
Reduces nutrient deficiency risks of strict vegan diets
Frequently Asked Questions
Q: Does a vegan diet always lower heart disease risk? A: While vegan diets show strong protective effects against cardiometabolic disease, the quality matters significantly. Vegan diets based on processed plant-based meats and refined carbohydrates may not provide the same benefits as whole-food plant-based diets.
Q: Can I get enough protein on a plant-based diet? A: Absolutely. Proper plant-based protein sources including legumes, tofu, tempeh, nuts, seeds, and whole grains provide sufficient amino acids for most individuals.
Q: Is a vegetarian diet as beneficial as a vegan diet? A: Both show cardiometabolic benefits. Vegetarian diets may have a slight nutrient absorption advantage, while vegan diets may show marginally greater cardiovascular benefits, but the difference is modest.
Q: Do I need supplements on a plant-based diet? A: Vitamin B12 supplementation is essential for vegan diets. Other considerations depend on individual assessment, but many people benefit from vitamin D, iodine, and algae-based omega-3 supplementation.
Q: How long before I see cardiometabolic improvements? A: Research shows measurable improvements in cardiometabolic markers within 6–12 months of consistent plant-based diet adherence.
KEY TAKEAWAYS
✓ Plant-based diets demonstrate robust protective effects against cardiometabolic disease, with 25–30% reduced cardiovascular disease risk
✓ Vegetarian and vegan dietary patterns improve critical cardiometabolic markers including LDL cholesterol, blood pressure, blood glucose, and inflammatory markers
✓ Gut microbiome changes represent an important but often-overlooked mechanism through which plant-based diets protect cardiovascular health
✓ Adherence to plant-based diets demonstrates dose-dependent benefits—greater dietary adherence yields greater cardiometabolic protection
✓ Successful plant-based diet adoption requires attention to vitamin B12, adequate plant-based protein, and sufficient micronutrient intake
✓ Omnivorous diets can support cardiometabolic health through mindful food choices emphasizing whole foods and limiting processed foods
✓ Flexitarian approaches combining predominantly plant-based eating with occasional animal products offer practical balance between health benefits and dietary sustainability
✓ Environmental benefits of plant-based diets align with health outcomes, making them sustainable choices for long-term disease prevention
CONCLUSION AND CALL TO ACTION
The scientific evidence from 2023–2025 presents a compelling case: plant-based dietary patterns offer substantial protection against cardiometabolic disease. Whether you adopt a fully vegan diet, follow vegetarian eating patterns, or embrace flexitarian principles, increasing plant food consumption and reducing processed meat intake are evidence-based strategies for cardiovascular disease prevention and improved metabolic health.
But here's the most important message: the best diet is one you can sustain. The evidence strongly supports plant-based diets for cardiometabolic benefits, yet many people thrive on vegetarian, flexitarian, or even thoughtfully planned omnivorous approaches that emphasize whole foods and limit processing.
Take Action Today
Assess Your Current Diet: How much of your intake comes from plant-based, whole foods versus processed options?
Set a Realistic Goal: Whether it's Meatless Mondays, gradually increasing plant food consumption, or full plant-based diet adoption, choose what aligns with your life.
Optimise Your Approach: If adopting plant-based diets, ensure adequate vitamin B12 supplementation and diverse plant-based protein sources.
Track Your Progress: Monitor how dietary changes affect your energy, digestion, and how you feel—these personal indicators often precede measurable cardiometabolic improvements.
Consult Healthcare Providers: Work with registered dietitians or healthcare professionals to personalize recommendations based on your individual cardiometabolic risk factors and health goals.
Your cardiovascular health is too important to leave to guesswork. The research is clear: prioritizing plant-based foods while limiting processed foods and saturated fats represents a science-backed path to cardiometabolic disease prevention.
The question isn't whether plant-based diets work—the evidence overwhelmingly demonstrates they do. The question is: what's your next step toward better heart health and metabolic wellness?
Disclaimer: This article is for informational purposes only and does not constitute medical advice. Individual circumstances vary, and treatment decisions should always be made in consultation with qualified healthcare professionals.
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REFERENCES
Agnoli, C., Baroni, L., Bertini, I., Ciappellano, S., Fabbri, A., Goggi, S., Metro, D., Papa, M., Sbarbati, R., Scarino, M. L., Pellegrini, N., & Sieri, S. (2023). A comprehensive review of healthy effects of vegetarian diets. Nutrition, Metabolism, and Cardiovascular Diseases: NMCD, 33(7), 1308–1315. https://doi.org/10.1016/j.numecd.2023.04.005
Asnicar, F., Manghi, P., Fackelmann, G., et al. (2025). Gut micro-organisms associated with health, nutrition and dietary interventions. Nature, 638, 215–223. https://doi.org/10.1038/s41586-025-09854-7
Peruvemba, S., Martinez, R., Sabaté, J., et al. (2025). Diets for dual cardiovascular and planetary health: A scoping review. Current Atherosclerosis Reports, 27, 122. https://doi.org/10.1007/s11883-025-01344-5
Wang, T., Masedunskas, A., Willett, W. C., & Fontana, L. (2023). Vegetarian and vegan diets: Benefits and drawbacks. European Heart Journal, 44(36), 3423–3439. https://doi.org/10.1093/eurheartj/ehad436
Wang, X. J., Steur, M., Kavousi, M., & Voortman, T. (2025). Adherence to plant-based diets and long-term changes in cardiometabolic markers: A longitudinal analysis in a population-based cohort. American Journal of Clinical Nutrition, 122(2), 424–432. https://doi.org/10.1016/j.ajcnut.2025.05.012