Heart disease remains the world’s leading cause of death, claiming millions of lives every year.
Many factors can influence a person’s risk, including age, family history, smoking, high blood pressure, diabetes, physical inactivity and diet.
Researchers are therefore interested in everyday foods that might help protect the heart over the long term.
A study led by researchers at Edith Cowan University in Australia suggests that vegetables naturally rich in nitrate may offer heart benefits.
The research found that people who regularly ate these vegetables tended to have slightly lower blood pressure and a lower risk of several forms of cardiovascular disease. The findings were published in the European Journal of Epidemiology.
Nitrate occurs naturally in many vegetables, particularly leafy greens and some root vegetables. Foods that can contain relatively high amounts include spinach, lettuce, arugula, beetroot, celery and radishes.
Nitrate from vegetables is converted by the body through several steps into nitric oxide, a substance that helps blood vessels relax.
When blood vessels relax and widen, blood can move through them more easily. This can help lower blood pressure and reduce the amount of work the heart must do. Over many years, high blood pressure can damage arteries and increase the risk of heart attack, stroke and other cardiovascular problems.
The researchers examined information from more than 50,000 people taking part in the Danish Diet, Cancer, and Health Study. Participants were followed for more than two decades, giving the team an opportunity to compare long-term eating patterns with later cardiovascular health. Their diets were used to estimate how much nitrate they obtained from vegetables.
People who consumed more vegetable nitrate had lower systolic blood pressure, which is the upper number in a blood pressure reading. On average, their systolic pressure was about 2.5 millimeters of mercury lower than that of people consuming less. This is a modest difference for an individual, but small shifts in average blood pressure can matter across a large population.
Higher vegetable nitrate intake was also associated with a lower risk of cardiovascular disease. Depending on the condition examined, the difference in risk ranged from about 12% to 26%. The strongest association was seen for peripheral artery disease, which was about 26% less common among people with higher intake.
Peripheral artery disease develops when arteries carrying blood to the limbs become narrowed, usually because fatty material builds up inside the vessels. It most often affects the legs and can cause pain while walking. The condition is also a warning sign of widespread blood vessel disease and is linked with a higher risk of heart attack and stroke.
The researchers also observed lower rates of conditions including heart attack, stroke and heart failure among people who consumed more nitrate-rich vegetables. However, the study was observational, meaning it found relationships rather than proving that the vegetables themselves directly prevented these diseases. People who eat more vegetables may also have other healthy habits that contribute to their lower risk.
One encouraging finding was that very large servings did not appear necessary. The researchers estimated that roughly one cup of raw nitrate-rich vegetables, or about half a cup when cooked, could provide much of the observed benefit. Eating substantially more did not appear to produce a clear additional advantage.
That makes the finding relatively easy to apply to an ordinary diet. Leafy greens can be added to salads, sandwiches or meals, while vegetables such as spinach can be lightly cooked and served as a side dish. Beetroot, celery and other vegetables provide additional ways to increase variety.
The study does not mean that one serving of vegetables can cancel out smoking, inactivity or an otherwise unhealthy diet. Heart health depends on many factors working together, and people with high blood pressure or cardiovascular disease may still need medicines and regular medical care. Vegetables are best viewed as one part of a broader heart-healthy eating pattern.
The research also has important limitations. Diet was estimated from information reported by participants, which can never measure food intake perfectly, and nitrate levels vary between vegetables and growing conditions. Because participants were observed rather than randomly assigned different diets, the study cannot establish cause and effect.
Still, the large number of participants and long follow-up period make the findings noteworthy. They also fit with existing evidence that diets rich in vegetables are associated with better cardiovascular health. Future controlled studies can help determine how much of the benefit comes specifically from nitrate and how much comes from the many other nutrients found in vegetables.
The study, led by Dr. Catherine Bondonno and colleagues at Edith Cowan University and published in the European Journal of Epidemiology, offers a practical message. A regular serving of leafy greens and other nitrate-rich vegetables may support healthier blood vessels and blood pressure.
For most people, adding more vegetables is a simple habit that can fit naturally into an overall healthy diet.
If you care about heart health, please read studies about how eating eggs can help reduce heart disease risk, and herbal supplements could harm your heart rhythm.
For more health information, please see recent studies about how drinking milk affects risks of heart disease and cancer, and results showing strawberries could help prevent Alzheimer’s disease.
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