Author Identifier
Catherine Bondonno
https://orcid.org/0000-0001-8509-439X
Lauren Blekkenhorst
https://orcid.org/0000-0003-1561-9052
Joshua Lewis
https://orcid.org/0000-0003-1003-8443
Nicola Bondonno
https://orcid.org/0000-0001-5905-444X
Jonathan Hodgson
Document Type
Journal Article
Publication Title
European Journal of Epidemiology
Publisher
Springer
School
Institute for Nutrition Research / School of Medical and Health Sciences
RAS ID
35688
Funders
Edith Cowan University - Open Access Support Scheme 2021
Funding information : https://doi.org/10.1007/s10654-021-00747-3
National Health and Medical Research Council
Grant Number
NHMRC Number : 1159914, 1116937, 1172987
Abstract
Whether the vascular effects of inorganic nitrate, observed in clinical trials, translate to a reduction in cardiovascular disease (CVD) with habitual dietary nitrate intake in prospective studies warrants investigation. We aimed to determine if vegetable nitrate, the major dietary nitrate source, is associated with lower blood pressure (BP) and lower risk of incident CVD. Among 53,150 participants of the Danish Diet, Cancer, and Health Study, without CVD at baseline, vegetable nitrate intake was assessed using a comprehensive vegetable nitrate database. Hazard ratios (HRs) were calculated using restricted cubic splines based on multivariable-adjusted Cox proportional hazards models. During 23 years of follow-up, 14,088 cases of incident CVD were recorded. Participants in the highest vegetable nitrate intake quintile (median, 141 mg/day) had 2.58 mmHg lower baseline systolic BP (95%CI − 3.12, − 2.05) and 1.38 mmHg lower diastolic BP (95%CI − 1.66, − 1.10), compared with participants in the lowest quintile. Vegetable nitrate intake was inversely associated with CVD plateauing at moderate intakes (~ 60 mg/day); this appeared to be mediated by systolic BP (21.9%). Compared to participants in the lowest intake quintile (median, 23 mg/day), a moderate vegetable nitrate intake (median, 59 mg/day) was associated with 15% lower risk of CVD [HR (95% CI) 0.85 (0.82, 0.89)]. Moderate vegetable nitrate intake was associated with 12%, 15%, 17% and 26% lower risk of ischemic heart disease, heart failure, ischemic stroke and peripheral artery disease hospitalizations respectively. Consumption of at least ~ 60 mg/day of vegetable nitrate (~ 1 cup of green leafy vegetables) may mitigate risk of CVD.
DOI
10.1007/s10654-021-00747-3
Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.
Comments
Bondonno, C. P., Dalgaard, F., Blekkenhorst, L. C., Murray, K., Lewis, J. R., Croft, K. D., . . . Hodgson, J. M. (2021). Vegetable nitrate intake, blood pressure and incident cardiovascular disease: Danish diet, cancer, and health study. European Journal of Epidemiology, 36(8), 813-825. https://doi.org/10.1007/s10654-021-00747-3