Nitrites, Nitrates, and Cardiovascular Outcomes: Are We Living “La Vie en Rose” With Pink Processed Meats?

Abstract

BACKGROUND: Nitrates and nitrites are used as food additives in processed meats. They are also commonly ingested from water and several foods. Several short-term clinical studies suggested beneficial effects of dietary nitrates on blood pres-sure, while deleterious effects on oxidative damage have been suggested in some experimental studies. However, there is a lack of evidence from longitudinal epidemiological studies linking foods and water-originated and additives-originated nitrites and nitrates, separately, to hypertension and cardiovascular diseases risk. We aimed to study these associations in a large population-based cohort. METHODS AND RESULTS: Overall, 106 288 adults from the French NutriNet-Santé cohort (2009– 2022) were included. Associations between nitrites and nitrates intakes and hypertension and cardiovascular disease risks were assessed using multi-adjusted Cox proportional hazard models. During follow-up, 3810 incident cases of hypertension and 2075 cases of cardiovascular diseases were ascertained. Participants with higher intakes of additives-originated nitrites (sodium nitrite in particular [European code e250]) had a higher hypertension risk compared with nonconsumers (hazard ratio, 1.19 [95% CI, 1.08–1.32], P=0.001, and 1.19 [95% CI, 1.08–1.32], P=0.002), respectively. No association was detected between foods and water-originated ni-trites, or nitrates with hypertension risk (all P values >0.3). We found no association between nitrites or nitrates and risks of cardiovascular diseases (all P values >0.2). CONCLUSIONS: These results do not support a protective role of nitrites or nitrates in cardiovascular health. Instead, they sug-gest a positive association between nitrites from food additives and hypertension risk, which needs confirmation in other large-scale studies. These findings provide new evidence in the context of current discussions about updating regulations on the use of nitrites as food additives.