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

Document Type

Journal Article


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.



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