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Fruit and vegetable intake and risk of cardiovascular disease: the Women's Health Study^1,2

¹ From the Division of Preventive Medicine and Channing Laboratory, the Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston; the Department of Ambulatory Care and Prevention, Harvard Medical School, Boston; the Departments of Epidemiology, Nutrition, and Health and Social Behavior, Harvard School of Public Health, Boston; and the Departments of Epidemiology and Public Health and Medicine, University of Miami School of Medicine.

Background: Prospective data relating fruit and vegetable intake to cardiovascular disease (CVD) risk are sparse, particularly for women.

Objective: In a large, prospective cohort of women, we examined the hypothesis that higher fruit and vegetable intake reduces CVD risk.

Design: In 1993 we assessed fruit and vegetable intake among 39876 female health professionals with no previous history of CVD or cancer by use of a detailed food-frequency questionnaire. We subsequently followed these women for an average of 5 y for incidence of nonfatal myocardial infarction (MI), stroke, percutaneous transluminal coronary angioplasty, coronary artery bypass graft, or death due to CVD.

Results: During 195647 person-years of follow-up, we documented 418 incident cases of CVD including 126 MIs. After adjustment for age, randomized treatment status, and smoking, we observed a significant inverse association between fruit and vegetable intake and CVD risk. For increasing quintiles of total fruit and vegetable intake (median servings/d: 2.6, 4.1, 5.5, 7.1, and 10.2), the corresponding relative risks (RRs) were 1.0 (reference), 0.78, 0.72, 0.68, and 0.68 (95% CI comparing the 2 extreme quintiles: 0.51, 0.92; P for trend = 0.01). An inverse, though not statistically significant, trend remained after additional adjustment for other known CVD risk factors, with RRs of 1.0, 0.75, 0.83, 0.80, and 0.85 (95% CI for extreme quintiles: 0.61, 1.17). After excluding participants with a self-reported history of diabetes, hypertension, or high cholesterol at baseline, the multivariate-adjusted RR was 0.45 when extreme quintiles were compared (95% CI: 0.22, 0.91; P for trend = 0.09). Higher fruit and vegetable intake was also associated with a lower risk of MI, with an adjusted RR of 0.62 for extreme quintiles (95% CI: 0.37, 1.04; P for trend = 0.07).

Conclusion: These data suggest that higher intake of fruit and vegetables may be protective against CVD and support current dietary guidelines to increase fruit and vegetable intake.

Key Words: Fruit • vegetables • cardiovascular disease • myocardial infarction • prospective study • women • Women's Health Study

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