Researchers studied people who had already experienced heart problems to see if eating more plant-based foods could help prevent future heart attacks and strokes. Over 24 years of tracking, they found that people who followed a plant-based eating pattern (called the EAT-Lancet diet) had fewer second heart events. Those who scored higher on the plant-based diet scale—meaning they ate more vegetables, fruits, whole grains, and fewer animal products—were significantly less likely to have a stroke. The results suggest that changing to a more plant-based diet might be a helpful way for people with heart disease to protect their health.

The Quick Take

  • What they studied: Whether eating a plant-based diet (the EAT-Lancet diet) could help people who already have heart disease avoid having another heart attack or stroke.
  • Who participated: Adults in the Netherlands who had already experienced heart disease or related blood vessel problems. Researchers tracked their eating habits and health outcomes over many years.
  • Key finding: People who ate more plant-based foods had a 24% lower risk of stroke and a 13% lower risk of heart events overall. For every 10-point increase on the plant-based diet score (out of 140 points), the risk of stroke dropped significantly.
  • What it means for you: If you have heart disease, eating more plant-based foods like vegetables, fruits, whole grains, and beans—while eating less meat and dairy—may help reduce your chances of having another heart attack or stroke. However, this doesn’t mean you must become fully vegetarian; even moving toward more plant-based eating appears helpful.

The Research Details

This was a long-term follow-up study of people with established heart disease in the Netherlands. Researchers asked participants detailed questions about what they ate using a food frequency questionnaire, which is a standard way to measure eating patterns. They then tracked these people over many years to see who had heart attacks or strokes.

The researchers created a score based on how closely each person’s diet matched the EAT-Lancet eating pattern, which emphasizes plant-based foods while limiting red meat, processed foods, and added sugars. They used statistical methods to compare people with higher plant-based diet scores to those with lower scores, while accounting for other factors that might affect heart health like age, sex, education, exercise, and smoking.

This approach is strong because it follows real people over a long time and measures their actual eating habits, rather than just asking them to remember what they ate.

This study design is important because it looks at people who already have heart disease—a group that really needs to know what dietary changes might help them. Previous research showed plant-based diets help healthy people avoid heart disease, but we didn’t know if they would help people who already had problems. By following people for many years and tracking their actual food choices, researchers could see real-world effects.

This study has several strengths: it followed a large group of people for a long time (24,212 person-years of data), it measured actual food intake rather than relying on memory, and it adjusted for many other factors that could affect the results. The study was published in a respected nutrition journal. However, the study was observational, meaning researchers watched what people ate rather than randomly assigning them to different diets, so we can’t be completely certain the diet caused the benefits.

What the Results Show

During the study period, 209 people had non-fatal heart attacks or strokes. The median score on the plant-based diet scale was 57 out of 140 points, showing that most people weren’t eating a fully plant-based diet.

People who scored higher on the plant-based diet scale had significantly lower risk of stroke. For every 10-point increase in the plant-based diet score, the risk of stroke dropped by 24%. This was a strong and clear finding.

For heart attacks specifically, there was a trend toward lower risk with higher plant-based diet scores (13% lower risk per 10-point increase), but this result was less definitive statistically. Overall vascular events (combining both heart attacks and strokes) showed a 13% lower risk with higher plant-based diet scores.

These results held true even after accounting for age, sex, education, exercise habits, smoking, and total calories eaten—meaning the plant-based diet itself appeared to be protective, not just a marker of healthier overall behavior.

The study found that the protective effect was particularly strong for stroke prevention. The results suggest that plant-based diets may work through multiple pathways—such as improving cholesterol levels, blood pressure, and inflammation—though the study didn’t directly measure these mechanisms. The fact that benefits appeared even in people who weren’t fully plant-based (median score was only 57 out of 140) suggests that even partial shifts toward plant-based eating may help.

Previous research in healthy people showed that plant-based diets reduce the risk of developing heart disease in the first place. This study extends that finding by showing that plant-based diets also help people who already have heart disease avoid future events. The magnitude of benefit (24% lower stroke risk) is consistent with what we see in other dietary intervention studies for heart disease patients.

The study was observational, so we can’t prove the diet caused the benefits—people eating more plant-based foods might also exercise more or have other healthy habits. The study was conducted in the Netherlands, so results might differ in other populations with different food availability or cultural eating patterns. The study measured diet at one point in time, but eating habits can change over years. Additionally, the study didn’t directly measure how much meat, dairy, or processed foods people ate, only how well their overall diet matched the EAT-Lancet pattern.

The Bottom Line

If you have heart disease, increasing plant-based foods in your diet appears to be beneficial, particularly for stroke prevention (strong evidence). Even partial shifts toward more vegetables, fruits, whole grains, and legumes—without necessarily becoming fully vegetarian—may provide protection. This recommendation aligns with current heart disease prevention guidelines. Confidence level: Moderate to High for stroke prevention; Moderate for overall heart event prevention.

This research is most relevant for people who have already had a heart attack, stroke, or been diagnosed with heart disease. It’s also relevant for people at high risk of heart disease. People without heart disease can benefit from plant-based eating for prevention, but this study specifically addresses those with established disease. Anyone considering major dietary changes should discuss it with their doctor, especially if they take blood-thinning medications or have other health conditions.

The benefits of dietary changes typically appear gradually. Research suggests that improvements in cholesterol and blood pressure can occur within weeks to months, but the reduction in actual heart events takes longer to measure—this study tracked people for years. You might expect to feel better and have improved energy within weeks, but the cardiovascular protection builds over months and years of consistent eating habits.

Want to Apply This Research?

  • Track daily servings of plant-based foods: vegetables (aim for 5+ servings), fruits (2-3 servings), whole grains (3+ servings), and legumes/beans (1-2 servings). Also track servings of red meat and processed foods to monitor reduction. Use a simple daily checklist or food diary feature.
  • Start by adding one plant-based meal per week, then gradually increase to 2-3 per week. Focus on meals you enjoy rather than restriction. Use the app to find plant-based recipes, set reminders for meal planning, and track progress toward higher plant-based diet scores. Create a personal goal like ‘increase plant-based diet score by 10 points per month.’
  • Monthly review of plant-based diet score trends, quarterly check-ins on how you feel (energy, digestion, weight), and annual discussions with your doctor about cardiovascular markers like cholesterol and blood pressure. Use the app to identify patterns—which plant-based foods you enjoy most, which meals are easiest to prepare, and which times of day you struggle with plant-based eating.

This research suggests an association between plant-based eating and reduced heart event risk in people with established cardiovascular disease, but it does not prove causation. Individual results may vary based on genetics, other health conditions, medications, and overall lifestyle. Anyone with heart disease, taking blood-thinning medications, or considering significant dietary changes should consult with their healthcare provider or registered dietitian before making major dietary modifications. This information is for educational purposes and should not replace professional medical advice. If you experience chest pain, shortness of breath, or other cardiac symptoms, seek immediate medical attention.