There is an inverse relationship between fruit and vegetable intake and coronary artery disease. According to data from a Nurses' Health Study, each additional serving of leafy green vegetables per day resulted in an 11% decrease in risk for CAD. Research has found that this is strongly correlated to the effects a diet high in polyphenols have on LDL oxidation and preventing further endothelial injury.

Plant-based diet and LDL oxidation

As a result of VEC dysfunction, LDL and monocytes migrate into the sub-endothelial space. This is the area located below the endothelial cells. Here, LDL becomes oxidized and promote monocytes to transform to macrophages.

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 Effects of a plant-based diet on CAD include prevention of 
progression of atherogenesis. Atherogenesis is the formation of fatty plaques on arterial walls. The steps of atherogenesis include: 
- Vascular endothelial cell injury
- LDL oxidation
- Macrophage activation

Plant-based diets can also have many other effects on CAD outside of the process of atherogenesis. These include:
- reduction in LDL and other lipoprotein levels
- reduced risk of a cardiovascular event (myocardial infarction, stroke, 
- reduction in all-cause mortality

Effects of a plant-based diet on coronary artery disease

Tuso, P., Stoll, S. R., & Li, W. W. (2015). A plant-based diet, atherogenesis, and coronary artery disease prevention. The Permanente journal, 19(1), 62–67. https://doi.org/10.7812/TPP/14-036 

A Plant-Based Diet, Atherogenesis, and Coronary Artery Disease Prevention

This diagram illustrates how certain components of the plant-based diet target specific stages of atherogenesis. Atherogenesis leads to atherosclerosis. By preventing stages of atherogenesis, the plant-based diet can prevent the development of atherosclerosis and thus coronary artery disease.

A Look at How Plant-Based Diets Target the Stages of Atherogenesis

Vascular endothelial cells make up the inner lining of arteries, veins, and capillaries. Vascular endothelial cells are active in maintaining homeostasis in the body by managing uptake, metabolism, and synthesis of many substances. When VECs are injured, they produce an inflammatory response. Dysfunctional VECs cannot produce nitric oxide or prevent the adhesion of LDL, platelets and monocytes to the VEC.

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