Blekkenhorst Lauren C, Bondonno Catherine P, Lewis Joshua R, Devine Amanda, Woodman Richard J, Croft Kevin D, Lim Wai H, Wong Germaine, Beilin Lawrence J, Prince Richard L, Hodgson Jonathan M
School of Medicine and Pharmacology, Royal Perth Hospital Unit, University of Western Australia, Perth, Western Australia, Australia;
School of Medicine and Pharmacology, Royal Perth Hospital Unit, University of Western Australia, Perth, Western Australia, Australia.
Am J Clin Nutr. 2017 Jul;106(1):207-216. doi: 10.3945/ajcn.116.146761. Epub 2017 May 31.
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. The objective was to investigate the association of nitrate intake from vegetables with ASVD mortality. 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. 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), = 0.002] and multivariable-adjusted [HR: 0.79 (95% CI: 0.68, 0.93), = 0.004] analyses. This relation was attenuated after further adjustment for diet quality [HR: 0.85 (95% CI: 0.72, 1.01), = 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), = 0.011]. 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.
富含硝酸盐的蔬菜可降低人体血压并改善内皮功能。然而，增加富含硝酸盐蔬菜的摄入量是否能降低动脉粥样硬化性血管疾病（ASVD）死亡率尚不清楚。本研究的目的是调查蔬菜硝酸盐摄入量与ASVD死亡率之间的关联。1998年共招募了1226名年龄在70 - 85岁、无ASVD和/或糖尿病病史的澳大利亚女性，并对她们进行了15年的研究。我们在基线时（1998年）评估了人口统计学和ASVD风险因素，并使用经过验证的食物频率问卷来评估饮食摄入量。通过使用新开发的综合数据库计算蔬菜中的硝酸盐摄入量。主要结局是通过西澳大利亚数据链接系统提供的关联数据确定的任何归因于ASVD的死亡。我们使用Cox比例风险模型来检验在调整生活方式和心血管疾病风险因素前后硝酸盐摄入量与ASVD死亡率之间的关联。在15947人年的随访期内，1226名女性中有238名（19.4%）死于ASVD相关原因。蔬菜硝酸盐摄入量的均值±标准差为67.0±29.2mg/d。在未调整分析[风险比（HR）：0.80（95%置信区间：0.70, 0.92），P = 0.002]和多变量调整分析[HR：0.79（95%置信区间：0.68, 0.93），P = 0.004]中，蔬菜硝酸盐摄入量每增加一个标准差，ASVD死亡率风险均降低。在进一步调整饮食质量后，这种关系减弱[HR：0.85（95%置信区间：0.72, 1.01），P = 0.072]。较高的蔬菜硝酸盐摄入量（每标准差）也与全因死亡率风险降低相关[多变量调整HR：0.87（95%置信区间：0.78, 0.97），P = 0.011]。在这群无ASVD或糖尿病病史的老年女性中，蔬菜硝酸盐摄入量与ASVD死亡率呈负相关，且独立于生活方式和心血管疾病风险因素。这些结果支持了富含硝酸盐的蔬菜可能降低与年龄相关的ASVD死亡率风险这一概念。该试验已在www.anzctr.org.au上注册，注册号为ACTRN12617000640303。
