Akin Ojagbemi1, Akinkunmi Paul Okekunle2, Paul Olowoyo3, Onoja Matthew Akpa4, Rufus Akinyemi5, Bruce Ovbiagele6, Mayowa Owolabi7. 1. Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria. 2. Department of Medicine, College of Medicine, University of Ibadan; University College Hospital, Ibadan, Nigeria; Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Ibadan, Nigeria; Epidemiology Laboratory, Department of Food and Nutrition, College of Human Ecology, Seoul National University, Seoul, Korea. 3. College of Medicine and Health Sciences, Afe Babalola University; Department of Medicine, Federal Teaching Hospital, Ado-Ekiti, Nigeria. 4. Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Ibadan, Nigeria; Centre for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria. 5. Centre for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria; Institute of Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria. 6. Weill Institute for Neurosciences; School of Medicine, University of California, San Francisco, California, USA. 7. Department of Medicine, College of Medicine, University of Ibadan; University College Hospital, Ibadan, Nigeria; Centre for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria; Department of Medicine, College of Medicine, University of Ibadan; University College Hospital; Blossom Specialist Medical Centre, Ibadan, Nigeria. Email: mayowaowolabi@yahoo.com.
Abstract
AIM: Low- and middle-income countries (LMICs) are currently experiencing increasing cardiovascular disease (CVD) rates. Green leafy vegetables (GLV), which are abundant in these countries, are known to be particularly rich in cardioprotective nutrients. This study sought to determine the specific effect of GLV intake on the incidence of CVD. METHODS: Previously published cohort studies on GLV intake and incidence of CVD were retrieved through a systematic search of Google Scholar, EMBASE, MEDLINE, HINARI and Cochrane Library. A methodological evaluation of studies was carried out using the network of Ottawa scale, and a fixed-effect meta-analysis was applied to estimate pooled relative risk (RR) and 95% confidence interval (CI). Heterogeneity was determined using the I2 statistic. Sensitivity analysis was done using the leave-one-study-out technique. All statistical analysis was carried out at p < 0.05 using RevMan 5.4. RESULTS: The pooled RR (95% CI) of incident CVD events from 17 studies was 0.93 (0.92-0.95). Specifically, GLV intake was inversely related with incident cerebral infarction (RR: 0.92; 95% CI: 0.88-0.96), heart disease (RR: 0.93; 95% CI: 0.87-0.99) and other CVD events (RR: 0.95; 95% CI: 0.93-0.98). CONCLUSIONS: GLV intake was associated with a lower incidence of CVD, and may be a promising primary-prevention strategy against CVD events. The findings are especially important in LMICs where the burden of CVD remains high.
AIM: Low- and middle-income countries (LMICs) are currently experiencing increasing cardiovascular disease (CVD) rates. Green leafy vegetables (GLV), which are abundant in these countries, are known to be particularly rich in cardioprotective nutrients. This study sought to determine the specific effect of GLV intake on the incidence of CVD. METHODS: Previously published cohort studies on GLV intake and incidence of CVD were retrieved through a systematic search of Google Scholar, EMBASE, MEDLINE, HINARI and Cochrane Library. A methodological evaluation of studies was carried out using the network of Ottawa scale, and a fixed-effect meta-analysis was applied to estimate pooled relative risk (RR) and 95% confidence interval (CI). Heterogeneity was determined using the I2 statistic. Sensitivity analysis was done using the leave-one-study-out technique. All statistical analysis was carried out at p < 0.05 using RevMan 5.4. RESULTS: The pooled RR (95% CI) of incident CVD events from 17 studies was 0.93 (0.92-0.95). Specifically, GLV intake was inversely related with incident cerebral infarction (RR: 0.92; 95% CI: 0.88-0.96), heart disease (RR: 0.93; 95% CI: 0.87-0.99) and other CVD events (RR: 0.95; 95% CI: 0.93-0.98). CONCLUSIONS: GLV intake was associated with a lower incidence of CVD, and may be a promising primary-prevention strategy against CVD events. The findings are especially important in LMICs where the burden of CVD remains high.
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