Abstract

The French paradox relates to the paradoxical association of a diet high in saturated fat and cholesterol with low coronary heart disease mortality and is contrary to the 'lipid hypothesis'. France and other regions with low heart disease mortality have a high consumption of fruit and vegetables. Epidemiologic studies show fruit and vegetable consumption is inversely related to coronary heart disease mortality, but recent intervention studies do not support the theory that protection is due to antioxidant vitamins. Fruit and vegetables, however, are rich sources of folate. Folate lowers plasma homocysteine levels. Even mild to moderate elevation in plasma homocysteine level is a strong risk factor for arteriosclerosis of the coronary, cerebral, and peripheral arteries. This should explain not only the French paradox but also why known risk factors may explain as little as 25% of the risk for coronary heart disease.