Background: The impact of dietary patterns on cardiovascular health remains a subject of intense research. This study aimed to compare the effects of plant-based, mixed, and animal-based diets on cardiovascular health outcomes. Methods: In this prospective cohort study, 9,847 participants aged 30-65 years were categorized into plant-based (n=3,282), mixed (n=3,945), and animal-based (n=2,620) diet groups based on food frequency questionnaires. Participants were followed for 5 years, with annual assessments of dietary patterns, cardiovascular risk factors, and events. Cox proportional hazards models and linear mixed-effects models were used to analyze the data. Results: Over the 5-year follow-up, 412 cardiovascular events occurred. Compared to the plant-based diet group, the hazard ratio for cardiovascular events was 1.32 (95% CI: 1.03-1.69) in the mixed diet group and 1.64 (95% CI: 1.26-2.13) in the animal-based diet group, after adjusting for confounders. The plant-based diet group showed significant improvements in cardiovascular risk factors, including blood pressure (−3.8/−2.2 mmHg), LDL cholesterol (−10.1 mg/dL), and BMI (−0.8 kg/m²), compared to the animal-based diet group (p<0.001 for all). These associations were consistent across age and sex subgroups. Conclusions: Adherence to a plant-based diet was associated with a lower risk of cardiovascular events and more favorable changes in cardiovascular risk factors compared to mixed or animal-based diets. These findings suggest that promoting plant-based dietary patterns could be an effective strategy for cardiovascular disease prevention.