Association Between Fruits and Vegetables Consumption and Premature Coronary Artery Disease ( PCAD ): A Multi‐Center Case Control Study

ABSTRACT Few investigations have examined the association of fruits and vegetables with premature coronary artery disease (PCAD) in the Eastern Mediterranean region. This study aimed to evaluate the association between fruits and vegetables intake and PCAD, as well as its severity. This multi‐centric case–control study was conducted in the framework of the Iran premature coronary artery disease (IPAD) study. Totally, 3249 participants aged < 60 years in men and < 70 years in women, who were referred for angiography to cardiac catheterization and coronary angiography units across 14 cities in Iran representing eight major Iranian ethnicities were examined. Cases were 2068 patients with a stenosis ≥ 75% in at least one vessel or ≥ 50% in the left main cardiac artery. The Control group was 1181 individuals with a normal angiography test. Dietary intake was assessed using the validated semi‐quantitative food frequency questionnaire (FFQ). After full adjustment for confounders, the inverse association with 91%, 96% and 95% PCAD risk reduction was manifest with most frequent fruit consumption (OR: 0.09, 95% CI: 0.06, 0.13), vegetable intake (OR: 0.04, 95% CI: 0.02, 0.06) and total fruits and vegetables consumption (OR: 0.05, 95% CI: 0.03, 0.07), respectively. In both genders, greater intake of fruits, vegetables, and total fruits and vegetables was considerably and negatively associated with the risk of PCAD. Furthermore, the severity of PCAD was inversely correlated with fruits and vegetables intake ( p < 0.001). We found an inverse relationship between fruits and vegetables consumption with odds of PCAD in Iranian ethnicities. Our findings highlight dietary habits' role in reducing PCAD risk and severity, guiding prevention and clinical care.