Dietary Intake of Anti-Oxidant Vitamins A, C, and E Is Inversely Associated with Adverse Cardiovascular Outcomes in Chinese—A 22-Years Population-Based Prospective Study

Bernard Cheung,Jean Woo,Helen Wan,Chi-Ho Lee,Edward Janus,Chloe Cheung,Yu-Cho Woo,Ruth Chan,Carol Fong,Tai-Hing Lam,Karen Lam

doi:10.3390/nu10111664

Abstract

Background: Conflicting and population-dependent findings have been reported from epidemiological studies on the associations of dietary intake of anti-oxidant vitamins with cardiovascular events. We investigated the prospective relationship between dietary intake of anti-oxidant vitamins and incident adverse cardiovascular outcomes amongst Hong Kong Chinese. Methods: In this prospective population-based study, baseline dietary intake of anti-oxidant vitamins (A, C, and E) were assessed using a food frequency questionnaire in 875 Chinese participants from the Hong Kong Cardiovascular Risk Factor Prevalence Study (CRISPS) in 1995–1996. The adjusted hazard ratio (HR) of incident adverse cardiovascular outcomes, defined as the first recorded diagnosis of cardiovascular deaths, non-fatal myocardial infarction or non-fatal stroke, and coronary or other arterial revascularizations, was calculated per unit intake of each vitamin using multivariable Cox regression. Results: Over a median follow-up of 22 years, 85 participants (9.7%) developed adverse cardiovascular outcomes. Dietary intakes of vitamin A, C, and E were independently and inversely associated with incident adverse cardiovascular outcomes (HR 0.68, 95%CI 0.53–0.88, p = 0.003 for vitamin A; HR 0.66, 95%CI 0.52–0.85, p = 0.001 for vitamin C; and HR 0.57, 95%CI 0.38–0.86, p = 0.017 for vitamin E) after adjustments for conventional cardiovascular risk factors at baseline. Conclusions: Dietary intakes of anti-oxidant vitamins A, C, and E reduced the risk of adverse cardiovascular outcomes in Hong Kong Chinese.

Highlights

Cardiovascular disease (CVD) is a significant global health burden [1,2]
In multivariable Cox regression analysis (Table 3), all three anti-oxidant vitamins A, C, and E were significantly associated with incident adverse cardiovascular outcomes after adjustments for age and sex (HR 0.67, 95%CI 0.53–0.86, p = 0.002 per IU of vitamin A; hazard ratio (HR) 0.66, 95%CI 0.51–0.84, p = 0.001 per mg of vitamin C; and HR 0.60, 95%CI 0.41–0.90, p = 0.012 per mg of vitamin E)
We demonstrated that low dietary intake of vitamins A, C, and E all independently predicted lower risk of adverse cardiovascular outcomes in Chinese, a very large subset of the human population, above and beyond conventional risk factors of cardiovascular diseases

Summary

Introduction

Cardiovascular disease (CVD) is a significant global health burden [1,2]. Strikingly, despite an overall decline in the age-standardized prevalence of CVD especially in high-income countries, cardiovascular mortality still accounted for a third of all deaths in 2015 [1]. Supplementation with anti-oxidant vitamins overall did not show a reduction of incident major cardiovascular outcomes (cardiovascular death, fatal or non-fatal myocardial infarction, stroke, or transient ischemic attack) in randomized controlled trials [5,6], preclinical studies have consistently demonstrated beneficial effects on atherosclerosis, mainly through the attenuation of lipid peroxidation and free radical induced damage, of anti-oxidant vitamins A [7], C [8], and E [9,10]. We investigated the relationship between dietary intake of anti-oxidant vitamins and incident adverse cardiovascular outcomes amongst Hong Kong. Conflicting and population-dependent findings have been reported from epidemiological studies on the associations of dietary intake of anti-oxidant vitamins with cardiovascular events.

Methods

Results

Discussion

Conclusion