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Observational epidemiological surveys (WG 3) page 48
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and 154 cases in the Bulgarian study by Georgieva et al., 1995) with patients already
suffering from either myocardial infarction (MI) or coronary heart disease (CHD) may be
reported. In both studies, an inverse association was found for consumption of fruit and
vegetables and risk of acute MI or CHD. All prospective studies are based on dietary intake
estimated either by food frequency questionnaire or by recall. In two studies, protective
effects were found for fruit and vegetables against stroke (Gillmann et al., 1995; Manson et
al., 1994) and four studies showed protection either against CHD or total circulatory disease
(Knekt et al., 1994, 1996; Gaziano et al., 1995; Sahyoun et al., 1996). The protection is
higher from vegetables than from fruit. Insufficient studies have been done to conclude on
which type of vegetable or which component is protective. However, Knekt et al., (1996)
found a protection of flavonoid-rich fruit and vegetables (i.e. apples, onions) and the
protection found by Gaziano et al., (1995) was from carotene-rich fruit and vegetables.
2-2 Lycopene and other Carotenoids (Tables 28-30)
As part of a European multicentre case-control study on antioxidants (EURAMIC),
carotenoids were measured in adipose tissue in 683 individuals with non fatal myocardial
infarction (MI) and 727 controls (Kardinaal et al., 1993). A borderline significant decreased
risk of intima media thickness (OR: 0.81, CI: 0.60-1.08) was observed in the ARIC study
(231 cases , 231 controls) based on lycopene plasma concentration after adjustment for all
confusion factors (Iribaren et al., 1997). An inverse association was found between
carotenoids and MI. After adjustment for age, body mass index, socioeconomic status,
smoking, hypertension, and maternal and paternal history of disease, lycopene remained
independently protective, with an odd ratio of 0.52 for the contrast of the 10th and 90th
percentiles (95% confidence interval 0.33-0.82, P = 0.005) (Kohlmeier et al., 1997).
Lycopene, or some substance highly correlated which is in a common food source, may
contribute to the protective effect of vegetable consumption on myocardial infarction risk.
In contrast, in the Street et al.,’s study, (1994), based on the determination of carotenoids
concentrations in the sera of patients with MI and controls, no association was observed with
lycopene level. There was a significantly increasing risk for subsequent myocardial infarction
with decreasing levels of β-carotene (P value for trend, 0.02) and a suggestive trend with
decreasing levels of lutein (P= 0.09). In addition, low serum levels of carotenoids were
associated with an increased risk of subsequent myocardial infarction among smokers. An
ecological study (Bobak et al., 1999) based on biochemical measurments of cardiovascular