The Portfolio Diet Tracked With Slightly Fewer Heart Disease Deaths

CATEGORY: EATING FOR HEART HEALTH

In a study that followed nearly 15,000 U.S. adults for about two decades, people whose everyday eating most closely resembled the “Portfolio diet“—a plant-forward mix of nuts, beans, oats, and plant-based oils—were about 16% less likely to die from cardiovascular disease than people whose diets resembled it least.¹ Cardiovascular disease refers to conditions affecting the heart and blood vessels, including heart attacks and strokes. Because this was an observational study, meaning researchers tracked what people already ate rather than assigning meals, it can show an association but cannot prove that the diet itself caused the lower risk.

Five Plant-Based Components That Target Cholesterol

The Portfolio diet is not a fad or a cleanse—it is a specific combination of foods studied for its effect on cholesterol, a fatty substance in your blood that can build up in artery walls. It brings together five plant-based components: nuts; plant protein such as beans, lentils, and soy foods like tofu; foods rich in viscous fiber (a sticky, gel-forming fiber found in oats and barley that helps sweep cholesterol out of the body); foods containing plant sterols (natural plant compounds that block some cholesterol from being absorbed); and plant-based sources of monounsaturated fat (a heart-friendly fat found in olive and other plant oils). The idea is that each part nudges cholesterol down a little, and together they may add up to a larger effect than any single food.

14,835 Adults Followed About 22 Years

Researchers drew on a large national health survey that recorded what 14,835 American adults ate, using a detailed interview about the previous day’s food plus a questionnaire about how often they ate various items. Each person received a Portfolio Diet Score based on how much their eating included the diet’s beneficial components and limited foods high in saturated fat and cholesterol. Participants were then sorted into three roughly equal groups—highest, middle, and lowest adherence—and their health records were linked to the National Death Index, a registry of death certificates, through the end of 2019. Over an average of about 22 years, the researchers recorded 2,300 deaths from cardiovascular disease and 6,238 deaths from all causes, then compared death rates across the three groups while accounting for factors such as age, smoking, and physical activity.¹ Those cardiovascular deaths included 1,887 from coronary heart disease and 413 from stroke over the 22 years of follow-up.¹

16% Lower Cardiovascular Death, 14% Lower Overall

Compared with the group whose diets least resembled the Portfolio pattern, the group with the closest match had a 16% lower rate of death from cardiovascular disease over the follow-up period.¹ The same top group also had a 14% lower rate of death from any cause. The link held for deaths from coronary heart disease specifically, the type of heart disease caused by narrowed heart arteries. These are relative differences between groups, not guarantees for any individual, and the size of the effect was modest rather than dramatic. Still, the pattern pointed consistently in the same direction across several outcomes, which strengthens the case that the association is real rather than a chance result.

Fiber and Sterols Limit Cholesterol Absorption

The plausible thread tying these foods together is cholesterol. Viscous fiber and plant sterols each interfere with how much cholesterol your body absorbs, nuts and plant oils supply fats that tend to be gentler on your arteries than saturated fat, and swapping in plant proteins often means less of the animal fat associated with higher cholesterol. None of this requires an unusual or restrictive way of eating—the study looked at ordinary, reasonable diets and simply asked how closely they leaned toward these plant foods. What it cannot tell you is whether people who ate this way were also healthier in other ways the researchers could not fully measure, which is a limitation of any observational study.

210,000 Health Professionals, 14% Lower Cardiovascular Risk

Other large studies point the same way. Following about 210,000 U.S. nurses and health professionals for up to 30 years, researchers found that people who scored highest on the same Portfolio pattern had a 14% lower risk of developing cardiovascular disease, and a 14% lower stroke risk, than those who scored lowest.² That work was also observational, so it shows an association rather than cause.

Key Takeaways

• In this long-term observational study, closer adherence to the Portfolio diet—nuts, beans and other plant proteins, oats and barley, plant sterols, and plant oils—was associated with about a 16% lower risk of dying from cardiovascular disease.
• Because the study observed existing eating habits rather than assigning them, it shows an association, not proof that the diet caused the lower risk.
• The Portfolio diet was built around foods studied for lowering cholesterol, and adherence was scored from participants’ own reported eating habits over years of follow-up.

References

1. Kavanagh ME, Zurbau A, Glenn AJ, et al. The portfolio dietary pattern and risk of cardiovascular disease mortality during 1988–2019 in US adults: a prospective cohort study. BMC Medicine. 2025;23:287. link
2. Glenn AJ, Guasch-Ferré M, Malik VS, et al. Portfolio diet score and risk of cardiovascular disease: findings from 3 prospective cohort studies. Circulation. 2023;148(22):1750–1763. link.