Antioxidant vitamins and coronary heart disease risk: a pooled analysis of 9 cohorts.
BACKGROUND
Epidemiologic studies have suggested a lower risk of coronary heart disease (CHD) at higher intakes of fruit, vegetables, and whole grain. Whether this association is due to antioxidant vitamins or some other factors remains unclear.


OBJECTIVE
We studied the relation between the intake of antioxidant vitamins and CHD risk.


METHODS
A cohort study pooling 9 prospective studies that included information on intakes of vitamin E, carotenoids, and vitamin C and that met specific criteria was carried out. During a 10-y follow-up, 4647 major incident CHD events occurred in 293 172 subjects who were free of CHD at baseline.


RESULTS
Dietary intake of antioxidant vitamins was only weakly related to a reduced CHD risk after adjustment for potential nondietary and dietary confounding factors. Compared with subjects in the lowest dietary intake quintiles for vitamins E and C, those in the highest intake quintiles had relative risks of CHD incidence of 0.84 (95% CI: 0.71, 1.00; P=0.17) and 1.23 (1.04, 1.45; P=0.07), respectively, and the relative risks for subjects in the highest intake quintiles for the various carotenoids varied from 0.90 to 0.99. Subjects with higher supplemental vitamin C intake had a lower CHD incidence. Compared with subjects who did not take supplemental vitamin C, those who took >700 mg supplemental vitamin C/d had a relative risk of CHD incidence of 0.75 (0.60, 0.93; P for trend <0.001). Supplemental vitamin E intake was not significantly related to reduced CHD risk.


CONCLUSIONS
The results suggest a reduced incidence of major CHD events at high supplemental vitamin C intakes. The risk reductions at high vitamin E or carotenoid intakes appear small.
Knekt
Paul
P
National Public Health Institute, Helsinki, Finland. paul.knekt@ktl.fi
Ritz
John
J
Pereira
Mark A
MA
O'Reilly
Eilis J
EJ
Augustsson
Katarina
K
Fraser
Gary E
GE
Goldbourt
Uri
U
Heitmann
Berit L
BL
Hallmans
Göran
G
Liu
Simin
S
Pietinen
Pirjo
P
Spiegelman
Donna
D
Stevens
June
J
Virtamo
Jarmo
J
Willett
Walter C
WC
Rimm
Eric B
EB
Ascherio
Alberto
A
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000975:Antioxidants / Q000008:administration & dosage* / Q000494:pharmacology; D001205:Ascorbic Acid / Q000008:administration & dosage* / Q000494:pharmacology; D002338:Carotenoids / Q000008:administration & dosage* / Q000494:pharmacology; D015331:Cohort Studies; D003327:Coronary Disease / Q000453:epidemiology* / Q000401:mortality; D004034:Diet Surveys; D019587:Dietary Supplements; D005260:Female; D005500:Follow-Up Studies; D005638:Fruit; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012306:Risk; D012307:Risk Factors; D014675:Vegetables; D014810:Vitamin E / Q000008:administration & dosage* / Q000494:pharmacology
D000975:Antioxidants; D014810:Vitamin E; D002338:Carotenoids; D001205:Ascorbic Acid