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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 32, No 4, July/August 2021

AFRICA

215

Dietary intakes of green leafy vegetables and incidence

of cardiovascular diseases

Akin Ojagbemi, Akinkunmi Paul Okekunle, Paul Olowoyo, Onoja Matthew Akpa, Rufus Akinyemi,

Bruce Ovbiagele, Mayowa Owolabi

Abstract

Aim:

Low- and middle-income countries (LMICs) are current-

ly experiencing increasing cardiovascular disease (CVD) rates.

Green leafy vegetables (GLV), which are abundant in these

countries, are known to be particularly rich in cardioprotec-

tive 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 stud-

ies was carried out using the network of Ottawa scale, and a

fixed-effect meta-analysis was applied to estimate pooled rela-

tive risk (RR) and 95% confidence interval (CI). Heterogeneity

was determined using the

I

2

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).

Conclusion:

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.

Keywords:

green leafy vegetables, cardiovascular diseases, cere-

bral infarction, coronary heart disease, heart disease, meta-

analysis

Submitted 14/10/20, accepted 14/4/21

Published online 10/6/21

Cardiovasc J Afr

2021;

32

: 215–223

www.cvja.co.za

DOI: 10.5830/CVJA-2021-017

Cardiovascular diseases (CVD) account for about 17.9 million

deaths annually

1

and a huge burden of health expenditure

worldwide.

2,3

Although CVD rates appear to be declining

globally,

1,2,4-6

populations in low- and middle-income countries

(LMIC)

6,7

continue to experience increasing CVD rates. CVD are

preventable and efforts are currently being mobilised to achieve

a 25% reduction in mortality rate attributable to CVD by 2025.

8,9

Review Article

Department of Psychiatry, College of Medicine, University of

Ibadan, Ibadan, Nigeria

Akin Ojagbemi, MB BS, MSc, PhD

Department of Medicine, College of Medicine, University of

Ibadan; University College Hospital, Ibadan, Nigeria

Akinkunmi Paul Okekunle, PhD,

akinokekunle@gmail.com

Mayowa Owolabi, MB BS, MSc, DrM, FAAN, FANA, FRCP,

FAcadMedS, FAS,

mayowaowolabi@yahoo.com

Department of Epidemiology and Medical Statistics, College

of Medicine, University of Ibadan, Ibadan, Nigeria

Akinkunmi Paul Okekunle, PhD

Onoja Matthew Akpa, BSc, MSc, PhD

Epidemiology Laboratory, Department of Food and Nutrition,

College of Human Ecology, Seoul National University, Seoul,

Korea

Akinkunmi Paul Okekunle, PhD

College of Medicine and Health Sciences, Afe Babalola

University; Department of Medicine, Federal Teaching

Hospital, Ado-Ekiti, Nigeria

Paul Olowoyo, MB BS, FWACP

Centre for Genomic and Precision Medicine, College of

Medicine, University of Ibadan, Ibadan, Nigeria

Onoja Matthew Akpa, BSc, MSc, PhD

Rufus Akinyemi, MB BS, MSc, PhD, MWACP, FMCP

Mayowa Owolabi, MB BS, MSc, DrM, FAAN, FANA, FRCP,

FAcadMedS, FAS,

mayowaowolabi@yahoo.com

Institute of Advanced Medical Research and Training,

College of Medicine, University of Ibadan, Ibadan, Nigeria

Rufus Akinyemi, MB BS, MSc, PhD, MWACP, FMCP

Weill Institute for Neurosciences; School of Medicine,

University of California, San Francisco, California, USA

Bruce Ovbiagele, MB BS, MSc, MAS, MBA, FAAN

Department of Medicine, College of Medicine, University

of Ibadan; University College Hospital; Blossom Specialist

Medical Centre, Ibadan, Nigeria

Mayowa Owolabi, MB BS, MSc, DrM, FAAN, FANA, FRCP,

FAcadMedS, FAS,

mayowaowolabi@yahoo.com