Methods: We prospectively observed 37698 men
from the Health Professionals Follow-up Study from
1986 to 2008 and 83644 women from the Nurses'
Health Study from 1980 to 2008 who were free of
cardiovascular disease(CVD) and cancer at baseline.
Diet was assessed by validated food frequency
questionaires and updated every 4 years.

Results: We documented 23926 deaths including
5910 CVD and 9464 cancer deaths during 2.96 million
person years of follow-up.
After multivariate adjustment for major lifestyle and
dietary risk factors, the pooled hazard ratio(HR)(95%CI)
of total mortality for a 1-serving-per-day increase was
1.13(1.07-1.20) for unprocessed red meat and
1.20(1.15-1.24) for processed red meat.
The corresponding HRs(95% CIs) were 1.18(1.13-1.23)
and 1.21(1.13-1.31) for CVD mortality and
1.10(1.06-1.14) and 1.16(1.09-1.23) for cancer mortality.
We estimated that substitutions of 1 serving per day of
other foods including fish, poultry, nuts, legumes, low fat
dairy, and whole grains for 1 serving per day of red meat
were associated with a 7% to 19% lower mortality risk.
We also estimated that 9.3% of deaths in men and
7.6% in women in these cohorts could be prevented
at the end of follow-up if all the individuals consumed
fewer than 0.5 servings per day, approximately
42 grams per day, of red meat.

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