| 21) Sesso HD. (2003) | The Women's Health Study. | 38,445 female health professionals aged ≥ 45 y, in a randomized, double-blind, placebo-controlled trial of low-dose aspirin and vitamin E in the primary prevention of CVD and cancer. | 6.9 | Total CVD risk (710), and
Important vascular events (504) | CVD risk | Apples |
Total cardiovascular disease
(MI, coronary artery bypass graft surgery, percutaneous transluminal coronary angioplasty, stroke, and CVD death) | Important vascular events
(myocardial infarction, stroke, and CVD death) |
RR = 0.78 (0.52-1.16; P = 0.74) for the highest vs lowest quartile of consumption.
Amount specific data (no. of apples/wk):
None: RR = 1.
≤ 1/wk: RR = 0.82 (0.64-1.04).
2-6/wk: RR = 0.87 (0.66-1.14).
≥ 1/d: RR = 0.78 (0.52-1.16).
|
RR = 0.66 (0.40-1.08; P = 0.56) for the highest vs lowest quartile of consumption.
Amount specific data (no. of apples/wk):
None: RR = 1.
≤ 1/wk: RR = 0.83 (0.62-1.11).
2-6/wk: RR = 0.96 (0.69-1.32).
≥ 1/d: RR = 0.66 (0.40-1.08).
|
Age, randomized aspirin treatment, randomized vitamin E treatment, randomized beta carotene treatment, total energy intake, BMI, exercise, alcohol intake, smoking, postmenopausal hormone use, parental history of myocardial infarctioin at age < 60, diabetes, hypertension, high cholesterol, fruit and vegetable intake, fiber intake, folate intake, and saturated fat intake. |
| 17) Mink PJ. (2007) | The Iowa Women's Health Study. | 34,489 postmenopausal women aged 55-69.
(USa) | 16
(1986-2002) | 2,316 | Cardiovascular disease mortality | Apples and pears |
RR = 0.87 (0.78-0.96; P = 0.019) for the highest vs lowest tertile of consumption.
Amount specific data (servings/wk):
< 1: RR = 1.
1: RR = 0.90 (0.79-1.01).
> 1: RR = 0.87 (0.78-0.96). | Age, energy intake, marital status, education, blood pressure, diabetes, BMI, waist-to-hip ratio, physical activity, smoking, and estrogen use. |
Coronary heart disease:
| Author | Cohort name | Subjects | Years of follow-up | Cases | End point | Consumption of | Relative Risk (RR) | Adjustments |
| 17) Mink PJ. (2007) | The Iowa Women's Health Study. | 34,489 postmenopausal women aged 55-69.
(USa) | 16
(1986-2002) | 1,329 | Coronary heart disease mortality | Apples and pears |
RR = 0.85 (0.75-0.98; P = 0.049) for the highest vs lowest tertile of consumption.
Amount specific data (servings/wk):
< 1: RR = 1.
1: RR = 0.88 (0.75-1.04).
> 1: RR = 0.85 (0.75-0.98). | Age, energy intake, marital status, education, blood pressure, diabetes, BMI, waist-to-hip ratio, physical activity, smoking, and estrogen use. |
| 17) Yochum L (1999) | The Iowa Women's Health Study. | 34,492 women aged 55-69.
(USA) | 10
(1986-1995) | 438 | Coronary heart disease death | Apples |
RR = 0.82 (0.60-1.12; P = 0.42) for the highest vs lowest quartile of consumption.
Amount specific data (times/week):
1: RR = 1.
1: RR = 0.98 (0.73-1.32).
2-4: RR = 0.92 (0.71-1.22).
5-42: RR = 0.82 (0.60-1.12). | Age, total energy intake, BMI squared, waist-to-hip ratio, high blood pressure, diabetes, estrogen replacement therapy, alcohol intake, education, marital status, pack-years of smoking, and physical activity, intake of cholesterol, saturated fat, vitamin E, dietary fiber, and whole grains. |
| 10) Lin J (2007) | The Nurses' Health Study. | 66,360 women aged 34-59.
(USA) | 12
(1990-2002) | Risk of nonfatal MI: 938.
CHD death: 324. | Risk of myocardial infarction, and
CHD death | Apples (apple juice, apple cider, and fresh apples) |
| Nonfatal MI | Fatal CHD |
RR = 1.08 (0.75-1.56; P = 0.80) for the highest vs lowest quintile of consumption.
Amount specific data (servings):
0-< 3/week: RR = 1.
3-< 5/week: RR = 0.99 (0.83-1.18).
5-< 7/week: RR = 0.87 (0.67-1.13).
1-< 2/day: RR = 1.06 (0.76-1.50).
≥ 2/day: RR = 1.08 (0.75-1.56).
|
RR = 0.73 (0.34-1.58; P = 0.73) for the highest vs lowest quintile of consumption.
Amount specific data (servings):
0-< 3/week: RR = 1.
3-< 5/week: RR = 0.91 (0.67-1.23).
5-< 7/week: RR = 1.29 (0.88-1.91).
1-< 2/day: RR = 0.95 (0.51-1.78).
≥ 2/day: RR = 0.73 (0.34-1.58).
|
Age; current smoking; parental history of myocardial infarction before age 60; history of hypertension, hypercholesterolemia, and diabetes; menopausal status; postmenopausal hormone use; use of aspirin; use of multivitamin and vitamin E supplements; BMI; physical activity; alcohol consumption; and total energy intake. |
| 10) Rimm EB. (1996) | The Health Professionals Follow-Up Study. | 34.789 male health professionals, 40 to 75 years of age.
(USA) | 6
(1986-1992) | Not defined. | Coronary heart disease mortality | Apples | RR = 1.01 (0.57-1.80; No P-value for consumption ≥ 1 apple/day vs none. | Nondietary factors for coronary heart disease in addition to intake of dietary fiber, saturated fat, and vitamin E. |
| 10) Rimm EB (1996) | The Health Professionals Follow-Up Study. | 43,757 men aged 40-75.
(USA) | 6
(1986-1992) | 734? | Risk of total MI (nonfatal MI and fatal coronary disease) | Apples | RR = 0.82 (0.58-1.17) for consumption 1 apple/day vs no consumption. | Not defined, but probably: Saturated fat, vitamin E, age, BMI, physical activity, smoking, alcohol, hypertension, hypercholesterolemia, family history of MI, and profession. |
| 7) Knekt P. (2002) | The Finnish Mobile Clinic Health Examination Cohort. | 10,054 men and women. | 28
(1967-1994) | 681? | Ischemic heart disease mortality | Apples | RR = 0.75 (0.60-0.94; P = 0.007).
No data shown, but probably for the highest vs lowest quartile of consumption.
The inverse association remained after adjustment for intake of vegetables and fruit other than apples. | Age, sex, geographic area, occupation, blood pressure, smoking, serum cholesterol, BMI, and diabetes. |
| 7) Knekt P (1996) | The Finnish Mobile Clinic Health Examination Cohort. | 5133 subjects (2748 men and 2385 women) aged 30-69. | 26
(1967-72 to 1992) | 473? | Coronary heart disease mortality | Apples |
| Men: | Women: |
| RR = 0.81 (0.61-1.09) for the highest vs lowest quartile of consumption (≥ 54 vs 0 g).
|
RR = 0.57 (0.36-0.91) for the highest vs lowest quartile of consumption (≥ 71 vs 0 g).
|
Adjustment for the intake of other fruits and vegetables, did not materially alter the results (data not shown).Age, smoking, serum cholesterol, hypertension, and BMI. |
| 6) Hertog MG (1993) | The Zutphen Elderly Study.
(The Dutch contribution to The Seven Countries Study) | 805 men aged 65-84.
(The Netherlands) | 5
(1985-1990) | Mortality from coronary heart disease: 43.
Myocardial infarction incidence: 38? | Coronary heart disease | Apples |
Mortality from coronary heart disease.
Stratified by method of adjustment:
| Age and diet | Age, diet, and risk factors |
RR = 0.50 (0.21-1.19; P = 0.13) for the highest vs lowest tertile of consumption.
Amount specific data (g/day):
0-18: RR = 1.
19-110: RR = 0.86 (0.43-1.75).
> 110: RR = 0.50 (0.21-1.19).
|
RR = 0.51 (0.23-1.16; P = 0.12) for the highest vs lowest tertile of consumption.
Amount specific data (g/day):
0-18: RR = 1.
19-110: RR = 0.90 (0.45-1.82).
> 110: RR = 0.51 (0.23-1.16).
|
No association was found with incidence of first myocardial infarction (P = 0.39).
Age and diet adjusted: History of myocardial infarction in 1985, intake of total energy, saturated fatty acids, cholesterol, coffee, alcohol, vitamin C, vitamin E, beta-carotene, and dietary fibre.
Age, diet, and risk factors adjusted: History of myocardial infarction in 1985, intake of total energy, and saturated fatty acids, physical activity, body-mass index, smoking, serum total and HDL cholesterol, and systolic blood pressure. |
Stroke:
| Author | Cohort name | Subjects | Years of follow-up | Cases | End point | Consumption of | Relative Risk (RR) | Adjustments |
| 17) Mink PJ. (2007) | The Iowa Women's Health Study. | 34,489 postmenopausal women aged 55-69.
(USa) | 16
(1986-2002) | 469 | Stroke mortality | Apples and pears |
RR = 0.85 (0.68-1.07; P = 0.284) for the highest vs lowest tertile of consumption.
Amount specific data (servings/wk):
< 1: RR = 1.
1: RR = 0.85 (0.64-1.12).
> 1: RR = 0.85 (0.68-1.07). | Age, energy intake, marital status, education, blood pressure, diabetes, BMI, waist-to-hip ratio, physical activity, smoking, and estrogen use. |
| 17) Yochum L (1999) | The Iowa Women's Health Study. | 34,492 women aged 55-69.
(USA) | 10
(1986-1995) | 131? | Stroke mortality | Apples | No association with stroke mortality (No data shown; P = 0.93). | Age, total energy intake, BMI squared, waist-to-hip ratio, high blood pressure, diabetes, estrogen replacement therapy, alcohol intake, education, marital status, pack-years of smoking, and physical activity, intake of cholesterol, saturated fat, vitamin E, dietary fiber, and whole grains. |
| 7) Knekt P. (2002) | The Finnish Mobile Clinic Health Examination Cohort. | 10,054 men and women. | 28
(1967-1994) | 423? | Thrombotic stroke incidence | Apples | RR = 0.75 (0.57-0.99; P = 0.009).
No data shown, but probably for the highest vs lowest quartile of consumption.
The inverse association remained after adjustment for intake of vegetables and fruit other than apples. | Sex, age, geographic area, occupation, blood pressure, smoking, serum cholesterol, BMI, and diabetes. |
| 7) Knekt P (2000) | The Finnish Mobile Clinic Health Examination Cohort. | 9,208 men and women aged ≥ 15.
(Finland) | 28
(1967-1994) | All cerebrovascular disease: 445 men, and 378 women.
Acute strokes: 309 men, and 259 women.
Thrombosis or embolia: 236 men, and 197 women.
Intracerebral haemorrhage: 55 men, and 40 women. | Cerebrovascular disease risk | Apple |
Men:
| All cerebrovascular disease | Acute strokes | Thrombosis or embolia | Intracerebral haemorrhage |
| RR = 0.65 (0.45-0.94; P = 0.85) for the highest vs lowest quartile of consumption (> 54 vs 0 g).
|
RR = 0.70 (0.45-1.07; P = 0.56) for the highest vs lowest quartile of consumption (> 54 vs 0 g).
|
A significantly decreased risk: RR = 0.59 (0.35-0.99; P = 0.45) for the highest vs lowest quartile of consumption (> 54 vs 0 g).
|
RR = 0.84 (0.32-2.19; P = 0.41) for the highest vs lowest quartile of consumption (> 54 vs 0 g).
|
Women:
| All cerebrovascular disease | Acute strokes | Thrombosis or embolia | Intracerebral haemorrhage |
| RR = 0.95 (0.60-1.51; P = 0.29) for the highest vs lowest quartile of consumption (> 71 vs < 5 g).
|
RR = 0.77 (0.44-1.33; P = 0.18) for the highest vs lowest quartile of consumption (> 71 vs < 5 g).
|
A significantly decreased risk: RR = 0.61 (0.33-1.12; P = 0.02) for the highest vs lowest quartile of consumption (> 71 vs < 5 g).
|
RR = 0.61 (0.15-2.49; P = 0.49) for the highest vs lowest quartile of consumption (> 71 vs < 5 g).
|
Adjustment for intake of other fruits and vegetables did not notably alter the results (data not shown).
No data was shown for quartile 2 and 3.
Age, serum cholesterol, BMI, smoking, hypertension, geographical region, diabetes and occupation, and intakes of quercetin, beta-carotene, vitamin E, vitamin C, fibre, saturated fatty acids, monounsaturated fatty acids, polyunsaturated fatty acids and energy. |
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