Heart Disease and Stroke

In an analysis comparing studies of more than 257,551 individuals, increasing daily fruit and vegetable intake was found to decrease risk of stroke. Fruits and vegetables are full of vitamin C, fiber, potassium, and antioxidants. In a study analyzing data from the Iowa Women’s Health Study, researchers found that pears and apples were the most protective against heart disease, compared with other common fruits (Am J ClinNutr, 2007). Compared with individuals who eat fewer than 3 servings of fruits and vegetables every day, those who eat three to five servings daily are 11% less likely to have a stroke. Those who eat more than 5 servings of fruits and vegetables every day have a risk reduction of 26%. These findings support eating more fruits and vegetables every day.

He FJ, Nowson CA, MacGregor GA. Fruit and vegetable consumption and stroke: meta-analysis of cohort studies. Lancet 2006; 367: 320-326.

In other research, the diets of 90,513 men and 141,536 women were observed and amounts of fruits and vegetables eaten were directly linked to stroke risk. For each additional serving of fruit, stroke risk was decreased by 11%! Although also protective, additional vegetable servings only decreased stroke risk by 3% each. This dose-response relationship suggests that fruit, and fruit and vegetable consumption, decrease the risk of stroke.

Dauchet L, Amoyel P, Dallongeville J. Fruit and vegetable consumption and risk of stroke: a meta-analysis of cohort studies. Neurology 2005;65(8):1193-1197.

Those who follow a prudent diet have a higher intake of fruits, vegetables, legumes, fish, and whole grains. This diet is thought to be a healthier pattern than the typical Western diet, which consists of a higher intake of red and processed meats, refined grains, french fries, sweets, and desserts. Previous studies have found strong associations between the Western diet and coronary heart disease and colon cancer:

In a study of 72,113 women free of illness, over 18 years 1154 died of cardiovascular death and 3139 died from cancer. The prudent diet was associated with a 28% lower risk of cardiovascular mortality, and 17% lower risk of all-cause mortality. Generally, the Western diet was associated with 22% higher risk of death from cardiovascular disease, 16% from cancer, and 21% of all causes of death. Thus, eating a healthful diet high in plant foods and lean meats may reduce risk of cardiovascular disease and overall mortality.

Heidemann C, Schulze MB, Franco OH, van Dam RM, Mantzoros CS, Hu FB. Dietary patterns and risk of mortality from cardiovascular disease, cancer, and all causes in a prospective cohort of women. Circulation 2008;118(3):230-237.

In a similar population, 69,017 women aged 38 to 63 years followed either a prudent or Western diet. Those following the Western eating plan on average ate up to 1.5 servings of fruit and up to 3.2 servings of vegetables per day. On the other hand, those following a more prudent plan ate up to 2.4 and 5.3 servings respectively. Overall, those following the Western plan were 1.64 times more likely to develop coronary heart disease (CHD). On the other hand, those following a more prudent eating plan had an inverse relationship with CHD; meaning, the more healthful foods eaten, the lower the risk for CHD. In a follow-up study of 71,768 women and risk for stroke, those who followed the Western diet most closely, had 1.58 times the risk of having a stroke compared to those who ate a more varied Western diet. Likewise, those who ate the most fruits and vegetables had a negative association with stroke. These findings suggest that including more fruits and vegetables in the diet as part of an overall healthy diet is protective against coronary heart disease and stroke.

Fung TT, Willett WC, Stampfer JM, Manson JE, Hu FB. Dietary patterns and the risk of coronary heart disease in women. Archives of Internal Medicine 2001;161:1857-1862.

Measuring vitamin C (ascorbic acid), the antioxidant vitamin, carried in the bloodstream is one way to assess fruit and vegetable intake. High levels in the bloodstream are associated with reduced risk for coronary artery disease, since it protects against oxidative damage that causes vascular injury. However, past studies have found that long-term supplementation with antioxidant pills did not offer any protective benefits. In a study of 979 individuals with no history of heart attack or stroke, those with the highest intake of ascorbic acid from fruits and vegetables had lower BMI, lower blood pressure, lower C-Reactive Protein (a marker of inflammation), and a higher HDL-cholesterol (the “good” cholesterol that protects against heart disease). Those with the highest levels of ascorbic acid had a 33% lower risk of developing coronary artery disease! This suggests that nutrients found in whole fruits work together synergistically, and offer more protection than supplements.

Boekholdt SM, Meuwese MC, Day NE, Luben R, Welch A, Wareham NJ, Khaw KT. Plasma concentrations of ascorbic acid and C-reactive protein, and risk of future coronary artery disease, an apparently health men and women: the EPIC-Norfolk prospective population study. British Journal of Nutrition 2006;96:516-522.

Fiber from fruits, vegetables, grains, and cereals may reduce the risk for cardiovascular disease by lowering blood pressure and reducing cholesterol. In a Harvard study of 91,058 men and 245,186 women, for every 10 grams of fiber eaten, a 14% decrease in risk for heart attacks and a 27% decrease in overall risk of dying from coronary heart disease were observed. This research also suggests that associations were strongest for fiber from fruit (30% decrease), followed second by cereal fiber (25% decrease).

Pereira MA, et al. Dietary fiber and risk of coronary heart disease. Archives of Internal Medicine 2004;164:370-376.