Refuting the Arguments against Meat on articles that claim Meat Causes Heart Disease/Atherosclerosis

1) Meat intake and mortality: a prospective study of over half a million people

Arch Intern Med. 2009 March 23; 169(6): 562–571

vii) Sinha’s conclusion was: “Red and processed meat intakes were associated with a modest increase in risk of total mortality, cancer and CVD mortality in both men and women. In contrast, high white meat intake was associated with a small decrease in total and cancer mortality.”

Sinha’s definition of red meat was: “Red meat included all types of beef and pork and included bacon, beef, cold cuts, ham, hamburger, hot dogs, liver, pork, sausage, steak and meats in foods such as pizza and chilli.” Sinha did not study red meat, therefore.


2) Red Meat Consumption and Mortality

Arch Intern Med. 2012;172(7):555-563.

Pooled analysis of Health Professionals Follow up Study and Nurses Health Study.

Conclusions: Red meat consumption is associated with an increased risk of total, CVD, and cancer mortality. Sub- stitution of other healthy protein sources for red meat is associated with a lower mortality risk.


Those with highest meat intake drank more alcohol, smoked more, were less physically active and had higher BMI.

Those with highest meat consumption had lower rate of high cholesterol


3) Major Dietary Protein Sources and Risk of Coronary Heart Disease in Women

Background—With the exception of fish, few major dietary protein sources have been studied in relation to the development of coronary heart disease (CHD). Our objective was to examine the relation between foods that are major dietary protein sources and incident CHD.

Methods and Results—We prospectively followed 84 136 women aged 30 to 55 years in the Nurses’ Health Study with no known cancer, diabetes mellitus, angina, myocardial infarction, stroke, or other cardiovascular disease. Diet was assessed by a standardized and validated questionnaire and updated every 4 years. During 26 years of follow-up, we documented 2210 incident nonfatal infarctions and 952 deaths from CHD. In multivariable analyses including age, smoking, and other risk factors, higher intakes of red meat, red meat excluding processed meat, and high-fat dairy were significantly associated with elevated risk of CHD. Higher intakes of poultry, fish, and nuts were significantly associated with lower risk. In a model controlling statistically for energy intake, 1 serving per day of nuts was associated with a 30% (95% confidence interval, 17% to 42%) lower risk of CHD compared with 1 serving per day of red meat. Similarly, compared with 1 serving per day of red meat, a lower risk was associated with 1 serving per day of low-fat dairy (13%; 95% confidence interval, 6% to 19%), poultry (19%; 95% confidence interval, 3% to 33%), and fish (24%; 95% confidence interval, 6% to 39%).

Conclusions—These data suggest that high red meat intake increases risk of CHD and that CHD risk may be reduced importantly by shifting sources of protein in the US diet. (Circulation. 2010;122:876-883.)


Red meat consumption included both processed and unprocessed.

Highest quintile (2.11 serving per day vs 0.49)

         No difference in BMI

         Higher smoker (19 vs 13%)

         Higher history of angina (10 vs 7) and HTN (41 vs 30)

         Higher history of incr cholesterol (39 vs 31)

         Higher history of DM (14 vs 8)

         Consumed more calories (2015 v 1326)

         Consumed more trans fats (5.2 vs 2.4g/d)

         Less active (15 vs 21 MET/wk)

Between 1980 and 2002, red meat consumption decreased from median 1.06 to 0.49 servings/day

Animal protein was associated with increased risk but only at highest quintile (1.0,0.94,0.96,0.96,1.14) – weak

When we included polyUS, monoUS and SF in the multivariate analysis, we found no correlation between animal protein and CHD risk

No significant trends were found doing multivariate analysis for each individual type of meat intake

No control for Trans Fats


Editorial: Although the “definitive” diet-heart trial has yet to be undertaken,randomized clinical trial data in the aggregate have not been inconsistent with epidemiological studies; the most harmful dietary influences include TFA intake and a high glycemic load, whereas monounsaturated and polyunsaturated fatty acids and certain complex carbohydrates appear to confer cardioprotection.

nurses who consumed the most red meat were also more likely to be hypertensive, smoke cigarettes, consume more TFA and total calories, and exercise less than their low-meat-eating colleagues. Although these confounders were adjusted for in multivariable analysis, leading a relatively unhealthy lifestyle may have been accompanied by additional exposures (eg, an increase in atherogenic remnant particles) or habits (eg, high glycemic load consumption) that were not captured in the model but that potentially compounded CHD risk.


4) Unprocessed Red and Processed Meats and Risk of Coronary Artery Disease and Type 2 Diabetes – An Updated Review of the Evidence


Growing evidence suggests that effects of red meat consumption on coronary heart disease (CHD) and type 2 diabetes could vary depending on processing. We reviewed the evidence for effects of unprocessed (fresh/frozen) red and processed (using sodium/other preservatives) meat consumption on CHD and diabetes. In meta-analyses of prospective cohorts, higher risk of CHD is seen with processed meat consumption (RR per 50 g: 1.42, 95 %CI = 1.07–1.89), but a smaller increase or no risk is seen with unprocessed meat consumption. Differences in sodium content (~400 % higher in processed meat) appear to account for about two-thirds of this risk difference. In similar analyses, both unprocessed red and processed meat consumption are associated with incident diabetes, with higher risk per g of processed (RR per 50 g: 1.51, 95 %CI = 1.25–1.83) versus unprocessed (RR per 100 g: 1.19, 95 % CI = 1.04–1.37) meats. Contents of heme iron and dietary cholesterol may partly account for these associations. The overall findings suggest that neither unprocessed red nor processed meat consumption is beneficial for cardiometabolic health, and that clinical and public health guidance should especially prioritize reducing processed meat consumption.


5) Risks of ischaemic heart disease and stroke in meat eaters, fish eaters, and vegetarians over 18 years of follow-up: results from the prospective EPIC-Oxford study


The EPIC-Oxford study, a cohort in the United Kingdom with a large proportion of non-meat eaters, recruited across the country between 1993 and 2001.


48 188 participants with no history of ischaemic heart disease, stroke, or angina (or cardiovascular disease) were classified into three distinct diet groups: meat eaters (participants who consumed meat, regardless of whether they consumed fish, dairy, or eggs;

n=24 428), fish eaters (consumed fish but no meat; n=7506), and vegetarians including vegans (n=16 254), based on dietary information collected at baseline, and subsequently around 2010 (n=28 364).


Incident cases of ischaemic heart disease and stroke (including ischaemic and haemorrhagic types) identified through record linkage until 2016.


Over 18.1 years of follow-up, 2820 cases of ischaemic heart disease and 1072 cases of total stroke (519 ischaemic stroke and 300 haemorrhagic stroke) were recorded. After adjusting for sociodemographic and lifestyle confounders, fish eaters and vegetarians

had 13% (hazard ratio 0.87, 95% confidence interval 0.77 to 0.99) and 22% (0.78, 0.70 to 0.87)

lower rates of ischaemic heart disease than meat eaters, respectively (P<0.001 for heterogeneity).

This difference was equivalent to 10 fewer cases of ischaemic heart disease (95% confidence interval 6.7 to 13.1 fewer) in vegetarians than in meat eaters per 1000 population over 10 years. The associations for ischaemic heart disease were partly attenuated after adjustment for self reported high blood cholesterol, high blood pressure, diabetes, and body mass index (hazard ratio 0.90, 95% confidence interval 0.81 to 1.00 in vegetarians with all adjustments). By contrast, vegetarians had 20% higher rates of total stroke (hazard ratio 1.20, 95% confidence interval 1.02

to 1.40) than meat eaters, equivalent to three more cases of total stroke (95% confidence interval 0.8 to 5.4 more) per 1000 population over 10 years, mostly due to a higher rate of haemorrhagic stroke. The associations for stroke did not attenuate after further adjustment of disease risk factors.


In this prospective cohort in the UK, fish eaters and vegetarians had lower rates of ischaemic heart disease than meat eaters, although vegetarians had higher rates of haemorrhagic and total stroke.


6) Meat Consumption and Fatal lschemic Heart Disease1

In 1960 the meat-consumption habits of 25,153 California Seventh-Day Adventists were assessed by questionnaire. Between 1960 and 1980 ischemic heart disease deaths were identified. Meat consumption was positively associated with fatal ischemic heart disease in both men and women. This association was apparently not due to confounding by eggs, dairy products, obesity, marital status, or cigarette smoking. The positive association be- tween meat consumption and fatal ischemic heart disease was stronger in men than in women and, overall, strongest in young men. For 45 to 64-year-old men, there was ap- proximately a threefold difference in risk between men who ate meat daily and those who did not eat meat. This is the first study to clearly show a dose-response relationship between meat consumption and ischemic heart disease risk. 

No differentiation in type of meat

Weak association (<2x)

Did not examine possible contributions of other dietary intake (i.e. carbs)


 Reviews that show no relation between meat and heart disease 

Patterns of Red and Processed Meat Consumption and Risk for Cardiometabolic and Cancer Outcomes

A Systematic Review and Meta-analysis of Cohort Studies

Ann Intern Med. 2019;171:732-741. doi:10.7326/M19-1583


Red and Processed Meat Consumption and Risk for All-Cause Mortality and Cardiometabolic Outcomes

A Systematic Review and Meta-analysis of Cohort Studies

Ann Intern Med. 2019;171:703-710. doi:10.7326/M19-0655


Effect of Lower Versus Higher Red Meat Intake on Cardiometabolic and Cancer Outcomes

A Systematic Review of Randomized Trials

Ann Intern Med. 2019;171:721-731. doi:10.7326/M19-0622