The findings come from a seven-year study of half a million adults in China, where fresh fruit consumption is much lower than in countries like the UK or US.
Researchers from the University of Oxford and Chinese Academy of Medical Sciences conducted a large, nationwide study of 500,000 adults from 10 urban and rural localities across China, tracking health for seven years through death records and electronic hospital records of illness.
The study was conducted among people who did not have a history of cardiovascular diseases or anti-hypertensive treatments when they first joined the study.
The study found that fruit consumption (which was mainly apples or oranges) was strongly associated with many other factors, such as lower blood pressure, lower blood glucose, and not smoking.
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A 100g portion of fruits per day was associated with about one-third less cardiovascular mortality and the association was similar across different study areas and in both men and women, researchers found.
"The association between fruit consumption and cardiovascular risk seems to be stronger in China, where many still eat little fruit, than in high-income countries where daily consumption of fruit is more common," said study author Dr Huaidong Du, from the University of Oxford.
"A recent Global Burden of Disease report put low fruit consumption as one of the leading causes of premature death in China. However, this was based on little evidence from China itself," said Professor Liming Li, from Chinese Academy of Medical Sciences.
"It's difficult to know whether the lower risk in people who eat more fresh fruits is because of a real protective effect," said Professor Zhengming Chen, from the University of Oxford.
The study was published in the New England Journal of Medicine.