Major CAD risk factors have also been shown to cause vascular endothelial cell injury. These include:
- hypercholesterolemia
- hypertension 
- diabetes
 
Other associated risks include hyperlipidemia and obesity.

Causes of vascular endothelial cell injury

Plant-based diets low in salt, fat, cholesterol, and sugar can cause reduction in VEC injury in patients with high risk for coronary artery disease. Because a plant-based approach includes no cholesterol due to the lack of animal products, this has shown promise for lowering LDL and other lipoprotein levels. Lowering intake of added sugars and salt can also improve diabetes and high blood pressure, which are common risk factors for developing CAD.

Properties of the plant-based diet that reduce/prevent vascular endothelial cell (VEC) injury

Vascular endothelial cells are active in maintaining homeostasis in the body by managing uptake, metabolism and synthesis of many substances. They also produce vasoprotective factors to protect arteries from atherogenesis.

Important functions of vascular endothelial cells

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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University of Michigan - Ann Arbor

 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 Cell Injury

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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