Introduction to the “A plant-based diet and cardiovascular disease” special issue

“All truth passes through three stages. First, it is ridiculed. Second, it is violently opposed. Third, it is accepted as being self-evident.” (Arthur Schopenhauer, German Philosopher, 17881866). Unlike many of our cardiovascular prevention and treatment strategies, including antioxidants, vitamin E, folic acid and niacin to name a few, that have disintegrated over time, the “truth” (i.e., evidence) for the benefits of plant-based nutrition continues to mount. This now includes lower rates of stroke, hypertension, diabetes mellitus, obesity, myocardial infarction and mortality, as well as many non-cardiac issues that affect our patients in cardiology, ranging from cancer to a variety of inflammatory conditions. Challenges with the science are, however, less daunting to overcome than inertia, culture, habit and widespread marketing of unhealthy foods. Our goal must be to get data out to the medical community and the public where it can actually change lives—creating healthier and longer ones. In 2015, cardiovascular mortality went up in the US for the first time in over four decades. We apparently have reached the tipping point in cardiology. The effects of our guideline-driven management for treatment of heart disease and its risk factors, and the benefits of our ever-more-creative interventions on acute events seem to have plateaued. The rising epidemic of obesity and diabetes is now outstripping our preventive efforts, adding to the cost of healthcare and costing lives. Starting with 2017 data, our Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) merit-based incentive payments and alternative payment models will be rewarding the absence of events more and more, and procedures less and less. So isn’t it time to move upstream, and place more emphasis on prevent-mode and less event-mode in our practices? Reading the existing literature and evaluating the impact of plant-based nutrition, it clearly represents the single most important yet underutilized opportunity to reverse the pending obesity and diabetes induced epidemic of morbidity and mortality.