Association of Vegetable Nitrate Intake With Carotid Atherosclerosis and Ischemic Cerebrovascular Disease in Older Women

Catherine P Bondonno; Lauren C Blekkenhorst; Richard L Prince; Kerry L Ivey; Joshua R Lewis; Amanda Devine; Richard J Woodman; Jon O Lundberg; Kevin D Croft; Peter L Thompson; Jonathan M Hodgson

doi:10.1161/STROKEAHA.117.016844

Association of Vegetable Nitrate Intake With Carotid Atherosclerosis and Ischemic Cerebrovascular Disease in Older Women

Stroke. 2017 Jul;48(7):1724-1729. doi: 10.1161/STROKEAHA.117.016844. Epub 2017 Jun 8.

Affiliations

¹ From the School of Medicine and Pharmacology, Royal Perth Hospital Unit (C.P.B., L.C.B., K.D.C., J.M.H.) and School of Medicine and Pharmacology, Sir Charles Gairdner Hospital (R.L.P.), University of Western Australia, Perth, WA; Departments of Endocrinology and Diabetes (R.L.P.) and Cardiovascular Medicine (P.L.T.), Sir Charles Gairdner Hospital, Perth, WA, Australia; Department of Nutrition and Epidemiology, Harvard T H Chan School of Public Health, Boston, MA (K.L.I.); South Australian Health and Medical Research Institute, Infection and Immunity Theme, School of Medicine, Flinders University, Adelaide, Australia (K.L.I.); School of Public Health, Sydney Medical School, The University of Sydney, NSW, Australia (J.R.L.); Centre for Kidney Research, Children's Hospital at Westmead, NSW, Australia (J.R.L.); School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia (C.P.B., A.D., J.M.H.); Discipline of General Practice, Flinders University, Adelaide, SA, Australia (R.J.W.); and Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden (J.O.L.). catherine.bondonno@uwa.edu.au.
² From the School of Medicine and Pharmacology, Royal Perth Hospital Unit (C.P.B., L.C.B., K.D.C., J.M.H.) and School of Medicine and Pharmacology, Sir Charles Gairdner Hospital (R.L.P.), University of Western Australia, Perth, WA; Departments of Endocrinology and Diabetes (R.L.P.) and Cardiovascular Medicine (P.L.T.), Sir Charles Gairdner Hospital, Perth, WA, Australia; Department of Nutrition and Epidemiology, Harvard T H Chan School of Public Health, Boston, MA (K.L.I.); South Australian Health and Medical Research Institute, Infection and Immunity Theme, School of Medicine, Flinders University, Adelaide, Australia (K.L.I.); School of Public Health, Sydney Medical School, The University of Sydney, NSW, Australia (J.R.L.); Centre for Kidney Research, Children's Hospital at Westmead, NSW, Australia (J.R.L.); School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia (C.P.B., A.D., J.M.H.); Discipline of General Practice, Flinders University, Adelaide, SA, Australia (R.J.W.); and Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden (J.O.L.).

PMID: 28596448
DOI: 10.1161/STROKEAHA.117.016844

Abstract

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.

Keywords: atherosclerosis; cardiovascular disease; cerebrovascular disease; nitrates; vegetables.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Carotid Artery Diseases / diet therapy*
Carotid Artery Diseases / epidemiology*
Carotid Artery Diseases / metabolism
Carotid Intima-Media Thickness / trends
Cerebrovascular Disorders / diet therapy*
Cerebrovascular Disorders / epidemiology*
Cerebrovascular Disorders / metabolism
Diet Records
Female
Hospitalization / trends
Humans
Life Style
Nitrates / administration & dosage*
Nitrates / metabolism
Surveys and Questionnaires / standards
Vegetables* / metabolism
Western Australia / epidemiology

Substances

Nitrates