title: Fruit and vegetable intake and risk of cardiovascular disease: the Women's Health Study.
abstract: 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.
  
  
  METHODS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Preventive Medicine and Channing Laboratory, the Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02215, USA. simin.liu@channing.harvard.edu
authors.forename: S
authors.initials: S
authors.lastname: Liu
authors.forename: J E
authors.initials: JE
authors.lastname: Manson
authors.forename: I M
authors.initials: IM
authors.lastname: Lee
authors.forename: S R
authors.initials: SR
authors.lastname: Cole
authors.forename: C H
authors.initials: CH
authors.lastname: Hennekens
authors.forename: W C
authors.initials: WC
authors.lastname: Willett
authors.forename: J E
authors.initials: JE
authors.lastname: Buring
mesh_terms: D000367:Age Factors; D000368:Aged; D000428:Alcohol Drinking; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000401:mortality / Q000517:prevention & control*; D015331:Cohort Studies; D004032:Diet / Q000706:statistics & numerical data*; D019587:Dietary Supplements; D015444:Exercise; D005260:Female; D005638:Fruit / Q000378:metabolism*; D006801:Humans; D008875:Middle Aged; D009203:Myocardial Infarction / Q000517:prevention & control*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D012907:Smoking; D011795:Surveys and Questionnaires; D014675:Vegetables / Q000378:metabolism*