The Effect of Fruit and Vegetable Intake on Risk for Coronary Heart Disease

  1. Kaumudi J. Joshipura, ScD;
  2. Frank B. Hu, MD;
  3. JoAnn E. Manson, MD;
  4. Meir J. Stampfer, MD;
  5. Eric B. Rimm, ScD;
  6. Frank E. Speizer, MD;
  7. Graham Colditz, MD;
  8. Alberto Ascherio, MD;
  9. Bernard Rosner, PhD;
  10. Donna Spiegelman, ScD; and
  11. Walter C. Willett, MD
  1. From Harvard School of Public Health, Harvard School of Dental Medicine, Channing Laboratory, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts.

    Abstract

    Background: Many constituents of fruits and vegetables may reduce the risk for coronary heart disease, but data on the relationship between fruit and vegetable consumption and risk for coronary heart disease are sparse.

    Objective: To evaluate the association of fruit and vegetable consumption with risk for coronary heart disease.

    Design: Prospective cohort study.

    Setting: The Nurses' Health Study and the Health Professionals' Follow-Up Study.

    Participants: 84 251 women 34 to 59 years of age who were followed for 14 years and 42 148 men 40 to 75 years who were followed for 8 years. All were free of diagnosed cardiovascular disease, cancer, and diabetes at baseline.

    Measurements: The main outcome measure was incidence of nonfatal myocardial infarction or fatal coronary heart disease (1127 cases in women and 1063 cases in men). Diet was assessed by using food-frequency questionnaires.

    Results: After adjustment for standard cardiovascular risk factors, persons in the highest quintile of fruit and vegetable intake had a relative risk for coronary heart disease of 0.80 (95% CI, 0.69 to 0.93) compared with those in the lowest quintile of intake. Each 1-serving/d increase in intake of fruits or vegetables was associated with a 4% lower risk for coronary heart disease (relative risk, 0.96 [CI, 0.94 to 0.99]; P = 0.01, test for trend). Green leafy vegetables (relative risk with 1-serving/d increase, 0.77 [CI, 0.64 to 0.93]), and vitamin C–rich fruits and vegetables (relative risk with 1-serving/d increase, 0.94 [CI, 0.88 to 0.99]) contributed most to the apparent protective effect of total fruit and vegetable intake.

    Conclusions: Consumption of fruits and vegetables, particularly green leafy vegetables and vitamin C–rich fruits and vegetables, appears to have a protective effect against coronary heart disease.

    Article and Author Information

    • Grant Support: By grants HL34595, HL35464 and CA40356, CA55075, and DE12102 from the National Institute of Health and by the Office of Dietary Supplements and the Florida Department of Citrus.

    • Acknowledgments: The authors thank the participants of the Health Professionals' Follow-up Study and the Nurses' Health Study for their continued cooperation and participation; Al Wing, Mira Kaufman, Karen Corsano, and Marcia Goetsch for computer assistance; Jill Arnold, Betsy Frost-Hawes, Kerry Demers, Mitzi Wolff, Gary Chase, and Barbara Egan for assistance in the compilation of data; and Laura Sampson for maintaining the food composition tables.

    • Requests for Single Reprints: Kaumudi J. Joshipura, ScD, Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, 188 Longwood Avenue, Boston MA 02115.

    • Current Author Addresses: Drs. Joshipura, Hu, Manson, Stampfer, Rimm, Speizer, Colditz, Ascherio, Rosner, Speigelman, and Willett: Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115.

    • Author Contributions: Conception and design: K.J. Joshipura, F.B. Hu, J.E. Manson, M.J. Stampfer, E.B. Rimm, F.E. Speizer, G. Colditz, A. Ascherio, W.C. Willett.

    • Analysis and interpretation of the data: K.J. Joshipura, F.B. Hu, J.E. Manson, M.J. Stampfer, E.B. Rimm, A. Ascherio, B. Rosner, D. Spiegelman, W.C. Willett.

    • Drafting of the article: K.J. Joshipura, F.B. Hu, W.C. Willett.

    • Critical revision of the article for important intellectual content: K.J. Joshipura, F.B. Hu, J.E. Manson, M.J. Stampfer, E.B. Rimm, A. Ascherio, B. Rosner, D. Spiegelman, W.C. Willett.

    • Final approval of the article: K.J. Joshipura, F.B. Hu, J.E. Manson, M.J. Stampfer, F.E. Speizer, G. Colditz, A. Ascherio, D. Spiegelman, W.C. Willett.

    • Provision of study materials or patients: M.J. Stampfer, E.B. Rimm, F.E. Speizer, G. Colditz.

    • Statistical expertise: K.J. Joshipura, B. Rosner, D. Spiegelman, W.C. Willett.

    • Obtaining of funding: K.J. Joshipura, J.E. Manson, E.B. Rimm, F.E. Speizer, G. Colditz, W.C. Willett.

    • Administrative, technical, or logistic support: K.J. Joshipura, E.B. Rimm, F.E. Speizer, G. Colditz, W.C. Willett.

    • Collection and assembly of data: M.J. Stampfer, E.B. Rimm, F.E. Speizer, G. Colditz, D. Spiegelman, W.C. Willett.

    Summary for Patients

    • Summaries for Patients:Eating Fruits and Vegetables Helps Prevent Coronary Heart Disease Ann Intern Med June 19, 2001 134:S14
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    1. Ann Intern Med June 19, 2001 vol. 134 no. 12 1106-1114
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