Association of vegetable nitrate intake with carotid atherosclerosis and ischemic cerebrovascular disease in older women

Document Type



Lippincott Williams and Wilkins


School of Medical and Health Sciences




Originally published as : Bondonno, C. P., Blekkenhorst, L. C., Prince, R. L., Ivey, K. L., Lewis, J. R., Devine, A., ... & Hodgson, J. M. (2017). Association of Vegetable Nitrate Intake With Carotid Atherosclerosis and Ischemic Cerebrovascular Disease in Older Women. Stroke, 48 (7), p 1724-1729. Article available here


Background and Purpose—A short-term increase in dietary nitrate (NO3) improves markers of vascular health via formation of nitric oxide and other bioactive nitrogen oxides. Whether this translates into long-term vascular disease risk reduction has yet to be examined. We investigated the association of vegetable-derived nitrate intake with common carotid artery intima-media thickness (CCA-IMT), plaque severity, and ischemic cerebrovascular disease events in elderly women (n=1226).

Methods—Vegetable nitrate intake, lifestyle factors, and cardiovascular disease risk factors were determined at baseline (1998). CCA-IMT and plaque severity were measured using B-mode carotid ultrasound (2001). Complete ischemic cerebrovascular disease hospitalizations or deaths (events) over 14.5 years (15 032 person-years of follow-up) were obtained from the West Australian Data Linkage System.

Results—Higher vegetable nitrate intake was associated with a lower maximum CCA-IMT (B=−0.015, P=0.002) and lower mean CCA-IMT (B=−0.012, P=0.006). This relationship remained significant after adjustment for lifestyle and cardiovascular risk factors (P≤0.01). Vegetable nitrate intake was not a predictor of plaque severity. In total 186 (15%) women experienced an ischemic cerebrovascular disease event. For every 1 SD (29 mg/d) higher intake of vegetable nitrate, there was an associated 17% lower risk of 14.5-year ischemic cerebrovascular disease events in both unadjusted and fully adjusted models (P=0.02).

Conclusions—Independent of other risk factors, higher vegetable nitrate was associated with a lower CCA-IMT and a lower risk of an ischemic cerebrovascular disease event.



Access Rights