Background: Consumption levels for saturated fats do not explain why mortality attributed to ischaemic heart disease (IHD) has generally fallen in established market economies but not in eastern Europe. We hypothesised that low intakes of fresh fruit and vegetables would be strongly associated with ischaemic heart disease in Bulgaria. Methods: Patients (n = 155) were admitted to the cardiology unit, Central Clinical Hospital, Sofia, aged 45 to 69, with confirmed diagnoses of ischaemic heart disease. Controls (n = 154) were patients admitted for minor elective Surgery. Measurements were made of blood pressure, height and weight and a blood sample taken around three days after admission. Subjects were interviewed before discharge and asked about the frequency with which they consumed fresh foods. Results: Reported frequency of fruit and vegetable intake was associated with the risk of IHD: odds ratio = 0.33 (95% CI 0.17 – 0.63) for fruit and 0.44 (95% CI 0.24 – 0.82) for vegetables for reported daily consumption versus reported consumption Ł 3 days per week. The association was independent of socio-demographic characteristics, cholesterol concentration, blood pressure, body mass index and reported physical activity. Conclusions: The potential of constituents of fresh fruit and vegetables to protect against ischaemic heart disease merits further investigation – especially in populations where intakes have been low for much of the year.

        Key words: coronary heart disease, diet, fruit, vegetables, risk factors