Relationship of dietary nitrate intake from vegetables with cardiovascular disease mortality: a prospective study in a cohort of older Australians

  • Alex H. Liu
  • Catherine P. Bondonno
  • Joanna Russell
  • Victoria M. Flood
  • Joshua R. Lewis
  • Kevin D. Croft
  • Richard J. Woodman
  • Wai H. Lim
  • Annette Kifley
  • Germaine Wong
  • Paul Mitchell
  • Jonathan M. Hodgson
  • Lauren C. BlekkenhorstEmail author
Original Contribution



Short-term trials indicate inorganic nitrate and nitrate-rich vegetables may have vascular health benefits. However, few observational studies have explored the relationship between nitrate intake and long-term cardiovascular disease (CVD) outcomes. The primary aim of this study was to investigate the association of nitrate intake from vegetables with CVD mortality in a sample of older Australians.


A subgroup of participants without diabetes or major CVD at baseline (1992–1994) were included from the Blue Mountains Eye Study, a population-based cohort study of men and women aged ≥ 49 years. Diets were evaluated using a validated food frequency questionnaire at baseline, 5 years and 10 years of follow-up. Vegetable nitrate intake was estimated using a comprehensive vegetable nitrate database. Cox proportional hazard regression was used to explore the association between vegetable nitrate intake and CVD mortality.


During 14 years of follow-up, 188/2229 (8.4%) participants died from CVD. In multivariable-adjusted analysis, participants in quartile 2 [69.5–99.6 mg/day; HR 0.53 (95% CI 0.35, 0.82)], quartile 3 [99.7–137.8 mg/day; HR 0.51 (95% CI 0.32, 0.80)], and quartile 4 [> 137.8 mg/day; HR 0.63 (95% CI 0.41, 0.95)] of vegetable nitrate intake had lower hazards for CVD mortality compared to participants in quartile 1 (< 69.5 mg/day).


In older Australian men and women, vegetable nitrate intake was inversely associated with CVD mortality, independent of lifestyle and cardiovascular risk factors. These findings confirm a recent report that intake of vegetable nitrate lowers the risk of CVD mortality in older women and extend these findings to older men.


Cardiovascular disease Mortality Nitrate Vegetables Coronary heart disease Stroke 



The analysis of this study was supported by a National Health and Medical Research Council (NHMRC) of Australia project Grant 1084922. The salaries of JRL and JMH were supported by NHMRC of Australia Fellowships. None of these funding agencies had any role in the conduct of the study; collection, management, analysis or interpretation of the data; or the preparation, review or approval of the manuscript.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

394_2018_1823_MOESM1_ESM.docx (126 kb)
Supplementary material 1 (DOCX 125 KB)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Alex H. Liu
    • 1
  • Catherine P. Bondonno
    • 1
    • 2
  • Joanna Russell
    • 3
  • Victoria M. Flood
    • 4
    • 5
  • Joshua R. Lewis
    • 1
    • 2
    • 6
    • 7
  • Kevin D. Croft
    • 1
  • Richard J. Woodman
    • 8
  • Wai H. Lim
    • 9
  • Annette Kifley
    • 10
  • Germaine Wong
    • 6
    • 7
  • Paul Mitchell
    • 10
  • Jonathan M. Hodgson
    • 1
    • 2
  • Lauren C. Blekkenhorst
    • 2
    Email author
  1. 1.Medical School, Royal Perth Hospital UnitThe University of Western AustraliaPerthAustralia
  2. 2.School of Medical and Health SciencesEdith Cowan UniversityJoondalupAustralia
  3. 3.School of Health and Society, Faculty of Social SciencesThe University of WollongongWollongongAustralia
  4. 4.Faculty of Health SciencesThe University of SydneySydneyAustralia
  5. 5.Western Sydney Local Health DistrictWestmead HospitalWestmeadAustralia
  6. 6.Centre for Kidney ResearchChildren’s Hospital at WestmeadWestmeadAustralia
  7. 7.School of Public Health, Sydney Medical SchoolThe University of SydneySydneyAustralia
  8. 8.Flinders Centre for Epidemiology and BiostatisticsFlinders UniversityAdelaideAustralia
  9. 9.Department of Renal MedicineSir Charles Gairdner HospitalNedlandsAustralia
  10. 10.Centre for Vision Research, Department of Ophthalmology, Westmead Institute for Medical ResearchThe University of SydneySydneyAustralia

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