Take your point on proving causality, but there are interesting selections of populations such as 200K health professionals or SDAs living in LA alongside their neighbors, that go a long way to mitigating confounding variables.
Here is a recent (2018) starting point into large (200k, etc.) studies, with various pooled analysis, meta analysis, RCTs, etc.:
This review summarizes the current evidence base examining the associations of plant-based diets with cardiovascular endpoints, and discusses the potential biological mechanisms underlying their health effects, practical recommendations and applications of this research, and directions for future research.
Healthful plant-based diets should be recommended as an environmentally sustainable dietary option for improved cardiovascular health.
The potentially beneficial role of plant-based diets in cardiovascular health has been increasingly recognized, with a vast and accumulating evidence-base documenting their health effects ...
Most recently, based on a comprehensive review of these studies, the Dietary Guidelines for Americans 2015–2020 included a healthy vegetarian-style dietary pattern in its recommendations of dietary patterns that can be adopted for improved health. In the present review, we will provide an overview of the cardiovascular benefits associated with plant-based diets, while discussing the biological pathways potentially involved, as well as clinical applications and public health implications of these findings.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6089671/
See Table 1 for RCTs and Figure 3 for emerging ‘causality’:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6089671/figure/...
Also read up on Blue Zones, and note the notion in this meta analysis of...
... the ”pro-vegetarian diet score”, defined by Martinez-Gonzalez et al. (6) as a diet which positively weighs plant foods while negatively weighing animal foods. They conceptualized such a diet as “a progressive and gentle approach to vegetarianism… that incorporates a range of progressively increasing proportions of plant-derived foods and concomitant reductions in animal-derived foods”...
... then think about the blue zones and balance/moderation and confounding variables in that light. It’s not a eating rice or olives or fishing and herding goats from a walkable village, versus sitting on couch watching TV and driving cars to the strip mall thing. Americans act American, so you can narrow down the causality to a kind of temperance.
https://www.bluezones.com/exploration/loma-linda-california/
Diet breakdown with “ancillary” meat: 10% dairy, 4% meat, 1% fish:
https://www.bluezones.com/wp-content/uploads/2016/07/303664_...