Vegetables and Artichokes Production and Cardiovascular and Cerebrovascular Diseases Mortality: An Ecological Study
Authors: Alberto Arnedo-Pena1,2,3*, Ma Rosario Pac-Sa2, Francisco Guillen-Grima1,4,5
1School of Health Sciences, Public University Navarra (UPNA), 31008 Pamplona, Spain
2Epidemiology Division. Public Health Center, 12003 Castello de la Plana, Spain
3Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
4Preventive Medicine, Clinica Universidad de Navarra, 31008 Pamplona, Spain
5Healthcare Research Institute of Navarre (IdiSNA), 31008 Pamplona, Spain
*Correspondence to: Alberto Arnedo-Pena, School of Health Sciences, Public University Navarra (UPNA), C/L’Olivera 5-2C. 12005 Castelló de la Plana, Spain; E-mail: albertoarnedopena@gmail.com
Received: July 02, 2021; Revision: July 15, 2021; Accepted: July 21, 2021; Published: July 26, 2021
Citation: Arnedo-Pena A, Pac-Sa MR, Guillen-Grima R (2021) Vegetables and Artichokes Production and Cardiovascular and Cerebrovascular Diseases Mortality: An Ecological Study. 21st Century Cardiol, Volume 1 (2): 106
Abstract
Cardiovascular disease (CDV), including cerebrovascular disease (CED) and ischemic heart disease (IHD) are multifactorial etiology. Several epidemiological approaches could be employed to prevent morbidity and mortality. With an ecological design, we analyzed mortality of CVD, CED, and IHD from 8 municipalities of Castellon's province with more than 20,000 inhabitants, in the Valencia Community (Spain) during the period 1991-2011, to estimate if the vegetables and artichokes production may be associated with lower CVD mortality. A municipality, Benicarló, highlighted the higher production of vegetables and artichokes, where artichokes are the main agricultural product (variety Cynara scolymus). In a multilevel linear regression analysis adjusted for potential confounding factors, vegetables and artichokes production was associated with reduced CED mortality and, to a lesser extent, CVD mortality. No significant effect on IHD mortality was found. In biological research, artichokes reduce total cholesterol, low-density lipoprotein cholesterol, triglyceride levels, and blood pressure. However, among other limitations, we postulated vegetables and artichoke production as a proxy of their consumption. In conclusion, the study found an inverse association between vegetables and artichoke production and CVD and CED mortality, and new studies are needed to confirm these results.
Keywords
Cardiovascular disease; Cerebrovascular; Vegetables; Artichoke; Production; Ecological design
Introduction
The International Classification of Diseases, 10th revision, addresses the conditions of the circulatory system or cardiovascular disease (CVD) as the principal causes of CVD death. It includes cerebrovascular disease (CED) and ischemic heart disease (IHD). These diseases have a chronic course, physiologic and metabolic complexity, and multifactorial etiology, from genetic, demographic, and socioeconomic to psychological, lifestyle and environment, including medical care and diet.
To prevent CVD morbidity and mortality: How to study a multifactorial etiology?
Several approaches could be employed. An epidemiological approach is the cohort study prospective or retrospective. The Framingham Heart Study was the first prospective cohort of CVD, and its excellent results continue today [1,2], and other cohort studies have left their mark [3,4]. The method consists of following a population free of CVD during years, detecting the new cases of CVD, and estimating associations with different factors (risk or protective factors). This methodology is expensive, time-consuming, and effective. If the potential factors are well measured, cause-effect relationships may be established, and many associated CVD factors were found [5,6]. However, many uncertainties remain considering the dynamic nature of CVD and geographic and cultural differences.
Another epidemiological approach is the ecological design. It is supported by preview information from different sources and a good knowledge of the terrain. It is non-expensive, rapid, and only permits a generation and evaluation of the hypothesis, the first stage of scientific research. Our study [7] analyzed mortality of CVD, CED, and IHD from 8 municipalities of Castell
References
1. Mahmood SS, Levy D, Vasan RS, et al. (2014) The framingham heart study and the epidemiology of cardiovascular disease: a historical perspective. Lancet 383: 999-1008.https://doi.org/10.1016/S0140-6736(13)61752-3
2. Cybulska B, K?osiewicz-Latoszek L (2019) Landmark studies in coronary heart disease epidemiology. The Framingham Heart Study after 70 years and the Seven Countries Study after 60 years. Kardiol Pol 77: 173-180. https://doi.org/10.5603/KP.a2019.0017
3. Lind L (2019) Population-based cardiovascular cohort studies in Uppsala. Ups J Med Sci 124: 16-20. https://doi.org/10.1080/03009734.2018.1515282
4. Kromhout D, Menotti A, Alberti-Fidanza A, et al. (2018) Comparative ecologic relationships of saturated fat, sucrose, food groups, and a Mediterranean food pattern score to 50-year coronary heart disease mortality rates among 16 cohorts of the Seven Countries Study. Eur J Clin Nutr 72: 1103-1110. https://doi.org/10.1038/s41430-018-0183-1
5. Toms R, Bonney A, Mayne DJ, et al. (2019) Geographic and area-level socioeconomic variation in cardiometabolic risk factor distribution: a systematic review of the literature. Int J Health Geogr 18: 1. https://doi.org/10.1186/s12942-018-0165-5
6. Yu E, Rimm E, Qi L, et al. (2016) Diet, lifestyle, biomarkers, genetic factors, and risk of cardiovascular disease in the Nurses' Health Studies. Am J Public Health 106: 1616-1623. https://doi.org/10.2105/AJPH.2016.303316
7. Arnedo-Pena A, Puig-Barberà J, Bellido-Blasco J, et al. (2020) Production of vegetables and artichokes is associated with lower cardiovascular mortality: An ecological study. Int J Environ Res Public Health 17: 6583. https://doi.org/10.3390/ijerph17186583
8. Naghshi S, Sadeghi O, Willett WC, et al. (2020) Dietary intake of total, animal, and plant proteins and risk of all-cause, cardiovascular, and cancer mortality: systematic review and dose-response meta-analysis of prospective cohort studies. BMJ 370: m2412. https://doi.org/10.1136/bmj.m2412
9. Tong TYN, Appleby PN, Key TJ, et al. (2020) The associations of major foods and fibre with risks of ischaemic and haemorrhagic stroke: a prospective study of 418 329 participants in the EPIC cohort across nine European countries. Eur Heart J 41: 2632-2640. https://doi.org/10.1093/eurheartj/ehaa007
10. Minich DM (2019) A Review of the science of colorful, plant-based food and practical strategies for “Eating the Rainbow”. J Nutr Metab 2019: 2125070. https://doi.org/10.1155/2019/2125070
11. Rolnik A, Olas B (2021) The plants of the Asteraceae family as agents in the protection of human health. Int J Mol Sci 22: 3009. https://doi.org/10.3390/ijms22063009
12. Cicero AFG, Fogacci F, Bove M, et al. (2019) Short-Term effects of dry extracts of artichoke and berberis in hypercholesterolemic patients without cardiovascular disease. Am J Cardiol 123: 588-591. https://doi.org/10.1016/j.amjcard.2018.11.018
13. Rondanelli M, Riva A, Petrangolini G, et al. (2020) The metabolic effects of Cynara supplementation in overweight and obese class I subjects with newly detected impaired fasting glycemia: A double-blind, placebo-controlled, randomized clinical trial. Nutrients 12: 3298. https://doi.org/10.3390/nu12113298
14. Turkiewicz IP, Wojdy?o A, Tkacz K, et al. (2019) Antidiabetic, anticholinesterase and antioxidant activity vs. terpenoids and phenolic compounds in selected new cultivars and hybrids of artichoke Cynara scolymus L. Molecules 24: 1222. https://doi.org/10.3390/molecules24071222
15. Rossoni G, Grande S, Galli C, et al. (2005) Wild artichoke prevents the age-associated loss of vasomotor function. J Agric Food Chem 53: 10291-10296. https://doi.org/10.1021/jf052499s