Intake of vegetables rich in carotenoids and risk of coronary heart disease in men: The Physicians' Health Study

Abstract

BACKGROUND: Previous studies of diet and coronary heart disease (CHD) have focused on intake of nutrients rather than whole foods. Because of the findings that dietary fibre, folate and antioxidants may be protective for CHD, increased intake of vegetables has been recommended. However, due to the chemical and physical complexity of vegetables, the effects of individual nutrients may differ if eaten as whole foods. Moreover, little is known about the direct association between vegetable intake and risk of CHD. METHODS: We prospectively evaluated the relation between vegetable intake and CHD risk in the Physicians' Health Study, a randomized trial of aspirin and beta-carotene among 22 071 US male physicians aged 40-84 years in 1982. In this analysis, we included 15 220 men without heart disease, stroke or cancer at baseline who provided information on their vegetable intake at baseline, and in the 2nd, 4th and 6th years of follow-up using a simple semiquantitative food frequency questionnaire including eight vegetables. We confirmed 1148 incident cases of CHD (387 incident cases of myocardial infarction and 761 incident cases of coronary artery bypass grafting or percutaneous transluminal coronary angioplasty) during 12 years of follow-up. RESULTS: After adjusting for age, randomized treatment, body mass index (BMI), smoking, alcohol intake, physical activity, history of diabetes, history of hypertension, history of high cholesterol, and use of multivitamins, men who consumed at least 2.5 servings/day of vegetables had a relative risk (RR) of 0.77 (95% CI : 0.60-0.98) for CHD, compared with men in the lowest category (<1 serving/day). Adjusting for the same covariates in an analysis of the overall trend that considered intake of vegetables as a continuous variable, we found a RR of 0.83 (95% CI : 0.71-0.98) for risk of CHD for each additional serving/day of vegetables. The inverse relation between vegetable intake and CHD risk was more evident among men with a BMI > or =25 (RR = 0.71, 95% CI : 0.51-0.99) or current smokers (RR = 0.40, 95% CI : 0.18-0.86) comparing highest to the lowest categories of intake. CONCLUSIONS: Our results suggest an inverse association between vegetable intake and risk of CHD. These prospective data support current dietary guidelines to increase vegetable intake for the prevention of CHD.