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Am J Clin Nutr. 2017 Jul;106(1):207-216. doi: 10.3945/ajcn.116.146761. Epub 2017 May 31.

Association of dietary nitrate with atherosclerotic vascular disease mortality: a prospective cohort study of older adult women.

Author information

1
School of Medicine and Pharmacology, Royal Perth Hospital Unit, University of Western Australia, Perth, Western Australia, Australia; lauren.blekkenhorst@research.uwa.edu.au.
2
School of Medicine and Pharmacology, Royal Perth Hospital Unit, University of Western Australia, Perth, Western Australia, Australia.
3
School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia.
4
School of Medicine and Pharmacology, Queen Elizabeth Medical Centre Unit, University of Western Australia, Nedlands, Western Australia, Australia.
5
Centre for Kidney Research, Children's Hospital at Westmead, Westmead, New South Wales, Australia.
6
School of Public Health, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.
7
Flinders Centre for Epidemiology and Biostatistics, Flinders University, Adelaide, South Australia, Australia; and.
8
Centre for Transplant and Renal Research, Westmead Hospital, Westmead, New South Wales, Australia.
9
Department of Renal Medicine, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.
10
Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.

Abstract

Background: Nitrate-rich vegetables lower blood pressure and improve endothelial function in humans. It is not known, however, whether increased consumption of nitrate-rich vegetables translates to a lower risk of atherosclerotic vascular disease (ASVD) mortality.Objective: The objective was to investigate the association of nitrate intake from vegetables with ASVD mortality.Design: A total of 1226 Australian women aged 70-85 y without prevalent ASVD and/or diabetes were recruited in 1998 and were studied for 15 y. We assessed demographic and ASVD risk factors at baseline (1998), and we used a validated food-frequency questionnaire to evaluate dietary intake. Nitrate intake from vegetables was calculated by use of a newly developed comprehensive database. The primary outcome was any death attributed to ASVD ascertained by using linked data that were provided via the Western Australian Data Linkage system. We used Cox proportional hazards modeling to examine the association between nitrate intake and ASVD mortality before and after adjustment for lifestyle and cardiovascular disease risk factors.Results: During a follow-up period of 15,947 person-years, 238 of 1226 (19.4%) women died of ASVD-related causes. The mean ± SD vegetable nitrate intake was 67.0 ± 29.2 mg/d. Each SD higher vegetable nitrate intake was associated with a lower risk of ASVD mortality in both unadjusted [HR: 0.80 (95% CI: 0.70, 0.92), P = 0.002] and multivariable-adjusted [HR: 0.79 (95% CI: 0.68, 0.93), P = 0.004] analyses. This relation was attenuated after further adjustment for diet quality [HR: 0.85 (95% CI: 0.72, 1.01), P = 0.072]. Higher vegetable nitrate intake (per SD) also was associated with a lower risk of all-cause mortality [multivariable-adjusted HR: 0.87 (95% CI: 0.78, 0.97), P = 0.011].Conclusions: Nitrate intake from vegetables was inversely associated with ASVD mortality independent of lifestyle and cardiovascular disease risk factors in this population of older adult women without prevalent ASVD or diabetes. These results support the concept that nitrate-rich vegetables may reduce the risk of age-related ASVD mortality. This trial was registered at www.anzctr.org.au as ACTRN12617000640303.

KEYWORDS:

atherosclerosis; atherosclerotic vascular disease; cardiovascular diseases; mortality; nitrate; vegetables

PMID:
28566306
DOI:
10.3945/ajcn.116.146761
[Indexed for MEDLINE]

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