Healthful plant-based dietary patterns, PM2·5 exposure and the risk of heart failure: a population-based cohort study

Abstract Fine particulate matter (PM 2·5 ) is a known risk factor for heart failure (HF), while plant-based dietary patterns may help reduce HF risk. This study examined the combined impact of PM 2·5 exposure and a plant-based diet on HF incidence. A total of 190 092 participants from the UK Biobank were included in this study. HF cases were identified through linkage to the UK National Health Services register, with follow-up lasting until October 2022 in England, August 2022 in Scotland and May 2022 in Wales. Annual mean PM 2·5 concentration was obtained using a land use regression model, while the healthful plant-based diet index (hPDI) was calculated using the Oxford WebQ tool based on two or more 24-hour dietary assessments of seventeen major food groups. Cox proportional hazard models assessed the associations of PM 2·5 and hPDI with HF risk, and interactions were evaluated on additive and multiplicative scales. During a median of 13·4-year follow-up, 4351 HF cases were recorded. Participants in the highest PM 2·5 tertile had a 23 % increased HF risk (hazard ratio: 1·23, 95 % CI: 1·14, 1·32) compared with those in the lowest tertile. Moderate or high hPDI was associated with reduced HF risk relative to low hPDI. The lowest HF risk was observed in individuals with high hPDI and low PM 2·5 exposure, underscoring the protective role of a plant-based diet, particularly in areas with lower PM 2·5 levels. A healthy plant-based diet may mitigate HF risk, especially in populations exposed to lower PM 2·5 levels.