Fruit and vegetable intake and risk of cardiovascular disease: the Women'sHealth Study

Background: Prospective data relating fruit and vegetable intake to cardiov ascular disease (CVD) risk are sparse, particularly for women. Objective: In a large, prospective cohort of women. we examined the hypothe sis that higher fruit and vegetable intake reduces CVD risk. Design: In 1993 we assessed fruit and vegetable intake among 39876 female h ealth professionals with no previous history of CVD or cancer by use of a d etailed food-frequency questionnaire. We subsequently followed these women for an average of 5 y for incidence of nonfatal myocardial infarction (MT), stroke, percutaneous transluminal coronary angioplasty. coronary artery by pass graft, or death due to CVD. Results: During 195 647 person-years of follow-up, we documented 418 incide nt cases of CVD including 126 Mis. After adjustment for age, randomized tre atment status, and smoking. we observed a significant inverse association b etween fruit and vegetable intake and CVD risk. Fur increasing quintiles of total fruit and vegetable intake (median servings/d: 2.6, 4.1, 5.5, 7.1, a nd 10.2), the corresponding relative risks (RRs) were 1.0 (reference), 0.78 , 0.72, 0.68, and 0.68 (95% CI comparing the 3 extreme quintiles: 0.51, 0.9 2; P for trend = 0.01). An inverse, though not statistically significant, t rend 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-a djusted RR was 0.45 when extreme quintiles were compared (95% CI, 0.22. 0.9 1, P for trend = 0.09). Higher fruit and vegetable intake was also associat ed with a lower risk of Mi, with an adjusted RR of 0.62 for extreme quantil es (95% CI: 0.37, 1.04: P for trend = 0.07). Conclusion: These data suggest that higher intake of fruit and vegetables m ay be protective against CVD and support current dietary guidelines to incr ease fruit and vegetable intake.