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Fruit, Veggies Cut Risk of IHD in Large Study
By Nancy Walsh, Staff Writer, MedPage Today
January 18, 2011

MedPage Today Action Points

Explain that in this study consuming eight or more portions of fruit and
vegetables each day was associated with a 22% reduction in the risk of fatal
ischemic heart disease compared with eating fewer than three portions.

Note that when the data were analyzed according to sex, a significant
reduction was seen only for women -- whose risk of dying of ischemic heart
disease fell by 15% with higher fruit and vegetable intake.

Review
People who want to significantly reduce their risk of dying from ischemic heart
disease may do well to greatly increase their daily intake of fruits and vegetables, a
large prospective European study suggests.

Among the more than 300,000 participants in the study, those who consumed eight
or more portions of fruit and vegetables each day had a reduction of 22% in their risk
of fatal ischemic heart disease (RR 0.78, 95% CI 0.65 to 0.95) compared with those
who ate fewer than three portions, according to Francesca L. Crowe, PhD, of the
University of Oxford in England, and colleagues.

In addition, increasing daily fruit and vegetable intake by just one portion (80 gm or
2.82 oz) led to a 4% decrease in risk of death from ischemic heart disease (RR 0.96,
95% CI 0.92 to 1), Crowe and co-authors reported online in the European Heart
Journal.

Many observational studies have found associations between fruit and vegetable
intake and the development of coronary heart disease, and the World Health
Organization has recommended a daily intake of 400 to 500 gm (around 14 to 18 oz)
per day -- about five or six portions a day of fruits and vegetables.

However, some uncertainty has persisted about the association because of

heterogeneity between studies, so Crowe and colleagues analyzed data from the
European Prospective Investigation into Cancer and Nutrition (EPIC) heart study, in
which 313,074 participants from 10 countries provided information about dietary
intake and other lifestyle factors such as smoking and exercise.

Participants' mean age at recruitment was 54 years, and their mean daily fruit and
vegetable intake was almost five servings.

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Medical News: Fruit, Veggies Cut Risk of IHD in Large Study - Pri... http://www.medpagetoday.com/tbprint.cfm?tbid=24410

Consumption of fruit and vegetables was lowest in Sweden, where men and women
ate 2.9 and 3.5 servings per day, respectively, while Italy and Spain had the highest
intakes, with a mean of more than six servings daily.

Higher fruit and vegetable intake was associated with older age, higher body mass
index, and greater overall energy intake -- but it was also linked with lower blood
pressure and less consumption of alcohol, cereal fiber, and saturated fat.

During an average of 8.4 years of follow-up, 1,636 participants died from ischemic
heart disease.

The relative risk of 0.78 for mortality from ischemic heart disease remained after
adjustment for saturated fat and cereal intake (RR 0.76, 95% CI 0.62 to 0.93).

And after adjustment for saturated fat and cereal -- dietary factors that may influence
cardiovascular risk -- there was a 5% decrease in risk of fatal ischemic heart disease
(RR 0.95, 95% CI 0.91 to 0.99).

When the associations with fruit and vegetable intakes were calculated separately,
the inverse association with ischemic heart disease mortality was nonsignificant --
but adjustment for cereal and saturated fat resulted in a statistically significant
association for fruit (RR 0.95, 95% CI 0.91 to 1.0, P=0.047 for trend).

When the data were analyzed according to sex, a significant reduction was seen
only for women, whose risk of dying of ischemic heart disease fell by 15%. In men,
the risk of dying decreased by 2%.

Future studies may clarify this gender difference -- which possibly relates to
smoking, the researchers noted.

It remains uncertain as to whether the decreased mortality risk relates to recognized

risk factors such as lipids and blood pressure, or whether other components of foods
are responsible.

A longstanding suggestion is that micronutrients in food have antioxidant effects that

help prevent atherosclerosis, although randomized trials of supplementation of
antioxidant vitamins have not confirmed benefits.

"It is, however, worth noting that consuming antioxidant supplements is not the same
as increasing the consumption of fruits and vegetables because there are many
other components in fruits and vegetables that may confer a cardioprotective effect,"
Crowe and colleagues observed.

In an accompanying editorial, Michael Marmot, PhD, of University College, London,

further explained the lack of protective effects in the antioxidant trials.

"Trials of antioxidant vitamins have not led to reductions in either cancer or

cardiovascular disease. That may be because antioxidant vitamins were not the
crucial protective components; or it is the foods and, indeed, dietary patterns that are
important, not specific micronutrients," Marmot wrote.

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Medical News: Fruit, Veggies Cut Risk of IHD in Large Study - Pri... http://www.medpagetoday.com/tbprint.cfm?tbid=24410

Preventing inflammation may also contribute, some experts say.

"A possible mechanism is the impact of fruit and vegetables to lower inflammation, a
known mechanism contributing to cardiovascular disease," suggested Stephen
Devries, MD, of Northwestern Memorial Hospital in Chicago, who was not involved in
the study.

Devries went on to tell MedPage Today and ABC News that this study's findings
represent "another reinforcement of the untapped power of nutrition to prevent heart
disease and stroke. These kind of results call out for greater emphasis on vegetable
and fruit intake by healthcare professionals and by those directing public health
policy."

Crowe and her colleagues noted that their study did have limitations, including the
unavailability of lipid and apolipoprotein measurements. There's also the possibility
that higher fruit and vegetable intake may reflect an overall healthier lifestyle.

The study was also observational in nature and cannot prove causality. The
researchers concluded that the biological mechanisms by which fruits and
vegetables may lower ischemic heart disease risk remains unclear.

The study was funded by numerous organizations including the Europe Against Cancer Program, the German
Federal Ministry of Education and Research, the Danish Cancer Society, the British Heart Foundation, the
Wellcome Trust, the Research Council of Norway, the Greek Ministry of Health and Social Solidarity, and the
Swedish Research Council.

All authors declared no financial conflicts of interest.

This article was developed in collaboration with ABC News.

Primary source: European Heart Journal

Source reference:
Crowe F, et al "Fruit and vegetable intake and mortality from ischaemic heart
disease: results from the European Prospective Investigation into Cancer and
Nutrition (EPIC)-Heart study" Eur Heart J 2011; DOI: 10.1093/eurheartj/ehq465.

Additional source: European Heart Journal

Source reference:
Marmot M "Fruit and vegetable intake reduces risk of fatal coronary heart disease"
Eur Heart J 2011; DOI: 10.1093/eurheartj/ehq506.

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