Unlike prior studies, this study demonstrated that greater adherence to a plant-based diet was not linked with cardiovascular disease (CVD) or all-cause mortality among black Americans.

• Researchers studied data on 3,635 African American adults from the Jackson Heart Study with a mean follow-up of 13 years to examine the relation of 3 plant-based dietary patterns (overall, healthy, and unhealthy) with CVD incidence and all-cause mortality.

• They assigned scores to participants’ adherence to 3 plant-based dietary patterns: an overall plant-based diet index (PDI), a healthy PDI (hPDI), and an unhealthy PDI (uPDI).

• Post-adjustment for sociodemographic features and health behaviors, no significant link was found between plant-based diets and incident CVD for overall PDI (hazard ratio [HR] 1.06), hPDI (HR 1.07), and uPDI (HR 0.95).

• For all-cause death risk with overall PDI, hPDI, and uPDI, the estimated corresponding HRs (95% CIs) were 0.96 (0.78–1.18), 0.94 (0.76–1.16), and 1.06 (0.86–1.30), respectively.

• Corresponding HRs (95% CIs) for incident coronary heart disease were 1.09 (0.74–1.61), 1.11 (0.76–1.61), and 0.79 (0.52–1.18), respectively, and for incident total stroke were 1.00 (0.66–1.52), 0.91 (0.61–1.36), and 1.26 (0.84–1.89), respectively.

• A lower risk for CVD was observed in relation to legumes intake, while vegetable oils were linked with higher risk for CVD, and higher all-cause mortality was observed in relation to whole grains and sugar-sweetened beverages.