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ESC Congress 2003: Consumption of Fruits and Vegetables Attenuates the Risk of Developing Acute Coronary Syndromes; The CARDIO2000 study

September 01, 2003

IMPORTANT: This press release accompanies a poster or oral session given at the ESC Congress 2003. Written by the investigator himself/herself, this press release does not necessarily reflect the opinion of the European Society of Cardiology

Among the conventional cardiovascular risk factors, diet poses a particular challenge for research. Cross-cultural comparisons, case-control and prospective observational studies identified a relationship between diet, blood pressure and lipids levels, but there is still considerable scientific uncertainty about the relationship between specific dietary components and cardiovascular risk, especially in Mediterranean populations. In this work we quantified the public health benefit of fruit and vegetable consumption on the primary prevention of acute coronary syndromes (acute myocardial infarction or unstable angina) using a large sample of cardiac patients and frequency-matched controls from all Greek regions.

The CARDIO2000 is a multicentre case-control study that explores the association between several demographic, nutritional, lifestyle, clinical and biochemical risk factors with the risk of developing non-fatal acute coronary syndromes. From January 2000 to March 2002, we randomly selected 848 coronary patients and 1078 cardiovascular symptom free subjects (controls).

The evaluation of the nutritional habits was accomplished with a validated questionnaire based on the guidelines from the Department of Nutrition of the National School of Public Health. We measured the consumption of several food items as an average per week during the past year. The frequency of consumption was quantified approximately in terms of the number of times per month this food was consumed.

The data analysis revealed that 365 (43%) of the cardiac patients and 722 (67%) of the controls consumed some quantity of fruit and vegetable daily. Of these:
"¢ 28 (3%) patients and 15 (1%) controls reported consuming < 1 serving/day;
"¢ 351 (41%) patients and 377 (35%) controls reported consuming 1 - 1.49 servings/day;
"¢ 344 (40%) patients and 428 (40%) controls reported 1.5 - 1.99 servings/day;
"¢ 100 (9%) patients and 150 (14%) controls reported 2 - 2.49 servings/day,
"¢ 33 (7%) patients and 100 (10%) controls consumed 2.5+ servings/day.

After adjusting for several cardiovascular risk factors, we revealed that those in the upper quintile of fruit consumption (5 or more items /day) had 72% lower relative cardiac risk compared with those in the lowest quintile of intake (<1 item /day). Similarly, consumption of vegetable more than 3 days / week was associated with 70% lower relative cardiac risk compared with those who did not consume vegetables.

Of particular interest, a 10% reduction in coronary risk was observed for every additional piece of fruit consumed per day. Moreover, in an analysis of the overall trend, considering vegetable intake as a continuous variable, we found a 19% reduction of the risk for developing coronary syndromes per each additional serving / day of vegetable consumed. However, the benefits from both fruits and vegetables intake on cardiac risk reach a plateau when we achieve high intake (> 2.5 servings / day).

The present study revealed that even a moderate consumption of fruit and vegetable (1 - 2 servings per day) was associated with significantly lower risk of coronary events, even after controlling for several potential confounding risk factors. Furthermore, the risk was progressively lower as the consumption of fruits or vegetables increased. Those in the highest quintile of consumption (2.5 or more serving per day) had about 70% lower relative risk when compared to those in the lowest quintile. The presented scientific evidences are sufficient to give good reason for public health education and promotion aimed at a substantial increase in the consumption of fruits and vegetables. However, our data do not suggest evidences for causality and population trials are needed in order to provide scientific proof of their efficacy.

Dr. Demosthenes Panagiotakos
Dr. Christina Chrysohoou
Assoc. Prof. Christos Pitsavos
Cardiology Clinic, School of Medicine, University of Athens, Greece

European Society of Cardiology (ESC)