The old proverb may stand the test of time, according to new research that suggests consuming an apple a day has the same benefits as statin drugs for people over 50.
A study published in the Christmas edition of the British Medical Journal (BMJ) suggests that 'prescribing' an apple a day to all adults aged 50 and over would prevent or delay around 8,500 vascular deaths such as heart attacks and strokes every year in the UK - a level similar that expected if statins were given to everybody over 50 years who is not already taking them, yet consuming apples would carry none of the side-effects.
Led by Dr Adam Briggs from the British Heart Foundation Health Promotion Research Group at Oxford University the study - which is based on model calculations - takes into account people who are already appropriately taking statins to reduce their risk of vascular disease and therefore the authors stress that no-one currently taking statins should stop, although by all means should eat more apples.
Using their calculations, the team also suggested that if adults of all ages could manage to eat an extra portion of fruit or vegetables per day, as many as 11,000 vascular deaths could be prevented every year.
"This study shows that small dietary changes as well as increased use of statins at a population level may significantly reduce vascular mortality," said the team.
"The Victorians had it about right when they came up with their brilliantly clear and simple public health advice: 'An apple a day keeps the doctor away'," said Briggs. "It just shows how effective small changes in diet can be, and that both drugs and healthier living can make a real difference in preventing heart disease and stroke."
Using mathematical models, the team set out to test how the 150 year old proverb might compare with the more widespread use of statins - using the total UK population as the model. They analysed the effect on the most common causes of vascular mortality of prescribing either a statin a day to those not already taking one or an apple a day to everyone aged over 50 years in the UK.
Briggs and his team assumed a 70% compliance rate and that overall calorie intake remained constant.
They estimated that 5.2 million people are currently eligible for statin treatment in the UK and that 17.6 million people who are not currently taking statins would be offered them if they became recommended as a primary prevention measure for everyone over 50.
Offering a daily statin to 17.6 million more adults would reduce the annual number of vascular deaths by 9,400, they found.
Meanwhile offering a daily apple to 70% of the total UK population aged over 50 years (22 million people) would avert 8,500 vascular deaths.
However, side-effects from statins mean that prescribing statins to everyone over the age of 50 is predicted to lead to over a thousand extra cases of muscle disease (myopathy) and over ten thousand extra diagnoses of diabetes, they team added.
Additional modelling showed a further 3% reduction in the annual number of vascular deaths when either apples or statins were prescribed to everybody aged over 30. But the number of adverse events was predicted to double for statins.
"While no-one currently prescribed statins should replace them for apples, we could all benefit from simply eating more fruit," said Briggs.
Published online ahead of print, open access, doi: 10.1136/bmj.f7267
"A statin a day keeps the doctor away: comparative proverb assessment modelling study"
Author: Adam D M Briggs