Fruit and vegetable intake and mortality from ischaemic heart disease: results from the European Prospective Investigation into Cancer and Nutrition (EPIC)-Heart study.
OBJECTIVE
A higher intake of fruits and vegetables has been associated with a lower risk of ischaemic heart disease (IHD), but there is some uncertainty about the interpretation of this association. The objective was to assess the relation between fruit and vegetable intake and risk of mortality from IHD in the European Prospective Investigation into Cancer and Nutrition (EPIC)-Heart study.


RESULTS
After an average of 8.4 years of follow-up, there were 1636 deaths from IHD among 313 074 men and women without previous myocardial infarction or stroke from eight European countries. Participants consuming at least eight portions (80 g each) of fruits and vegetables a day had a 22% lower risk of fatal IHD [relative risk (RR) = 0.78, 95% confidence interval (CI): 0.65-0.95] compared with those consuming fewer than three portions a day. After calibration of fruit and vegetable intake to account for differences in dietary assessment between the participating centres, a one portion (80 g) increment in fruit and vegetable intake was associated with a 4% lower risk of fatal IHD (RR = 0.96, 95% CI: 0.92-1.00, P for trend = 0.033).


CONCLUSIONS
Results from this large observational study suggest that a higher intake of fruits and vegetables is associated with a reduced risk of IHD mortality. Whether this association is causal and, if so, the biological mechanism(s) by which fruits and vegetables operate to lower IHD risks remains unclear.
Cancer Epidemiology Unit, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK. francesca.crowe@ceu.ox.ac.uk
Francesca L
FL
Crowe
Andrew W
AW
Roddam
Timothy J
TJ
Key
Paul N
PN
Appleby
Kim
K
Overvad
Marianne U
MU
Jakobsen
Anne
A
Tjønneland
Louise
L
Hansen
Heiner
H
Boeing
Cornelia
C
Weikert
Jakob
J
Linseisen
Rudolf
R
Kaaks
Antonia
A
Trichopoulou
Gesthimani
G
Misirli
Pagona
P
Lagiou
Carlotta
C
Sacerdote
Valeria
V
Pala
Domenico
D
Palli
Rosario
R
Tumino
Salvatore
S
Panico
H Bas
HB
Bueno-de-Mesquita
Jolanda
J
Boer
Carla H
CH
van Gils
Joline W J
JW
Beulens
Aurelio
A
Barricarte
Laudina
L
Rodríguez
Nerea
N
Larrañaga
Maria-José
MJ
Sánchez
María-José
MJ
Tormo
Genevieve
G
Buckland
Eiliv
E
Lund
Bo
B
Hedblad
Olle
O
Melander
Jan-Håkan
JH
Jansson
Patrik
P
Wennberg
Nicholas J
NJ
Wareham
Nadia
N
Slimani
Isabelle
I
Romieu
Mazda
M
Jenab
John
J
Danesh
Valentina
V
Gallo
Teresa
T
Norat
Elio
E
Riboli
D004032:Diet / Q000401:mortality*; D005060:Europe / Q000453:epidemiology; D005260:Female; D005638:Fruit; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000401:mortality*; D011446:Prospective Studies; D012307:Risk Factors; D014675:Vegetables
JAMA. 1997 May 28;277(20):1624-32
9168293
Lancet. 2007 Dec 1;370(9602):1829-39
18061058
World Health Organ Tech Rep Ser. 2003;916:i-viii, 1-149, backcover
12768890
Lancet. 2002 Jun 8;359(9322):1969-74
12076551
BMJ. 1997 Jun 21;314(7097):1787-91
9224079
Blood Press Monit. 2002 Apr;7(2):95-104
12048426
N Engl J Med. 1997 Apr 17;336(16):1117-24
9099655
Am J Clin Nutr. 1999 Sep;70(3 Suppl):475S-490S
10479220
Public Health Nutr. 2003 Jun;6(4):407-13
12795830
Am J Hypertens. 2002 Aug;15(8):691-6
12160191
Public Health Nutr. 2002 Dec;5(6B):1125-45
12639223
Epidemiology. 2001 Jan;12(1):62-7
11138821
Ann Intern Med. 2001 Jun 19;134(12):1106-14
11412050
JAMA. 2009 Nov 11;302(18):1993-2000
19903920
N Engl J Med. 1997 Aug 7;337(6):408-16
9241131
J Hum Hypertens. 2007 Sep;21(9):717-28
17443205
Public Health Nutr. 2002 Aug;5(4):561-5
12186665
Am J Clin Nutr. 2002 Jul;76(1):93-9
12081821
Am J Clin Nutr. 2009 Jul;90(1):1-10
19439460
Rev Saude Publica. 2000 Aug;34(4):380-7
10973158
Public Health Nutr. 2002 Dec;5(6B):1179-96
12639226
J Nutr. 2006 Oct;136(10):2588-93
16988131
Eur J Clin Nutr. 2000 Dec;54(12):900-17
11114689
JAMA. 2006 Feb 8;295(6):655-66
16467234
JAMA. 2005 Jul 20;294(3):351-8
16030280
Int J Epidemiol. 2008 Apr;37(2):368-78
18180242
Public Health Nutr. 2002 Dec;5(6B):1113-24
12639222
Int J Epidemiol. 2001 Feb;30(1):130-5
11171873
Am J Clin Nutr. 2004 Feb;79(2):213-7
14749225
Bull World Health Organ. 2005 Feb;83(2):100-8
15744402
Nat Rev Cardiol. 2009 Sep;6(9):599-608
19652655
J Nutr. 2008 Jun;138(6):1129-34
18492845
Am J Clin Nutr. 2000 Oct;72(4):922-8
11010932
Eur J Epidemiol. 2007;22(2):129-41
17295097
Am J Epidemiol. 2001 Feb 15;153(4):394-403
11207158
Cardiovasc Drugs Ther. 2002 Sep;16(5):411-5
12652110