Results:

A total of 135,335 adults were enrolled between January 1, 2003, and March 31, 2013. During a median 7.4 years (5.5-9.3 years) of follow-up, 4,784 major CVD events, 1,649 CV deaths, and 5,796 total deaths occurred. Combined mean fruit, vegetable, and legume intake was 3.91 (standard deviation 2.77) servings per day. Higher total fruit, vegetable, and legume intake was inversely associated with major CVD, MI, CV mortality, non-CV mortality, and total mortality after adjustment for age, sex, and study site. After further adjustment for additional factors including current smoking, diabetes status, physical activity, education, meat intake, and bread/cereal intake, these associations were substantially attenuated. The estimates were substantially attenuated in the multivariable adjusted models. For major CVD, the hazard ratio (HR) was 0.90 (95% confidence interval [CI], 0.74-1.10), with <1 serving per day as a reference group. A similar association was observed for MI (HR, 0.99; 95% CI, 0.74-1.31), stroke (HR, 0.92; 95% CI, 0.67-1.25), CV mortality (HR, 0.73; 95% CI, 0.53-1.02), and non-CV mortality (HR, 0.84; 95% CI, 0.68-1.04). Only total mortality remained statistically significant (HR, 0.81; 95% CI, 0.68-0.96). When examined separately, fruit intake was associated with lower risk of CV, non-CV, and total mortality, while legume intake was inversely associated with non-CV death and total mortality. For vegetables, raw vegetable intake was strongly associated with a lower risk of total mortality, whereas cooked vegetable intake showed a modest benefit against mortality.