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To study total, processed, and unprocessed red meat in relation to risk of coronary heart disease (CHD) and to estimate the effects of substituting other protein sources for red meat with CHD risk.

Prospective cohort study with repeated measures of diet and lifestyle factors.

Health Professionals Follow-Up Study cohort, United States, 1986-2016.

43 272 men without cardiovascular disease or cancer at baseline.

The primary outcome was total CHD, comprised of acute non-fatal myocardial infarction or fatal CHD. Cox models were used to estimate hazard ratios and 95% confidence intervals across categories of red meat consumption. Substitution analyses were conducted by comparing coefficients for red meat and the alternative food in models, including red meat and alternative foods as continuous variables.

During 1 023 872 person years of …