Eating More Fruits and Vegetables Lowers CAC Burden in Women: CARDIA

March 28, 2014

WASHINGTON, DC — Long-term follow-up from the Coronary Artery Risk Development in Young Adults (CARDIA) study suggests that a higher consumption of fruits and vegetables in women is associated with a lower risk of developing coronary atherosclerosis.

Interestingly, the association between a diet rich in fruits and vegetables and coronary artery atherosclerosis was not observed in men, a finding that has been reported in previous trials.

"We know that lifestyle behaviors are really the foundation of cardiovascular-disease prevention, including diet," said lead investigator Dr Michael Miedema (Minneapolis Heart Institute, MN) during a media briefing announcing the results. "There are several studies showing that a diet high in fruits and vegetables in middle-aged adults is associated with less coronary heart disease. As your fruit and vegetable intake goes up, your relative risk for developing coronary heart disease goes down. It's been seen in several other studies, but it's been most consistent in women."

The analysis, to be presented this week here at the American College of Cardiology 2014 Scientific Sessions , included 2648 men and women aged 18 to 30 years old. Its purpose, according to Miedema, was to focus on a younger group of individuals to determine the long-term benefits of fruits and vegetables on later heart-disease risk as assessed by the presence of coronary artery calcification (CAC).

Individuals were categorized into tertiles based on the number of fruit and vegetable servings consumed daily. For the 1610 women included in the study, those in tertile 1, 2, and 3 ate 3.3, 5.4, and 8.8 servings of fruit and/or vegetables each day. For the 1038 men included in the analysis, those in tertile 1, 2, and 3 consumed 2.6, 4.3, and 7.1 servings daily.

After 20 years of follow-up, there was a significant trend toward a lower risk of CAC prevalence with increasing consumption of fruits and vegetables in women. For men, however, a similar reduction in CAC prevalence was not observed across the tertiles.

"The women in the top third were about 40% less likely to have any coronary plaque compared with the women in the bottom third 20 years after assessing their diet," said Miedema. "In men, we did not find that same relationship. We really found no relationship between fruit and vegetable intake and the prevalence of having plaque in the arteries 20 years later."

When investigators adjusted for cardiovascular risk factors such as blood pressure and cholesterol levels, the relationship between diet and CAC prevalence was unchanged in the men and women.

Miedema noted that the INTERHEART study also showed that fruits and vegetables provided protection against cardiovascular disease, but the association was statistically significant only in women. While the CARDIA analysis suggests that men do not appear to benefit as much from eating more fruits and vegetables, the study included just over 1000 men and might have been underpowered to observe an association. The consumption of fruits and vegetables provides other benefits, Miedema noted, including cancer prevention and improved fertility, aside from reduced coronary calcification.

The take-home message should not be that fruits and vegetables provide no benefit in men, said Miedema. However, at the present time they simply don't have any plausible biological reasons why eating more fruits and vegetables might provide greater benefit in women than in men.

Full results from this study are being presented during ACC 2014 but were released early via a special preconference press briefing focused on consumer-interest news.

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