Abstract
Extensive evidence has demonstrated that many antioxidants such as vitamin C, vitamin E, carotenoids and polyphenols have protective effects in preventing cardiovascular disease (CVD), a chronic disease that is mediated by oxidative stress and inflammation. This review focuses on evidence from prospective cohort studies and clinical trials in regard to the associations between plasma/dietary antioxidants and cardiovascular events. Long-term, large-scale, population-based cohort studies have found that higher levels of serum albumin, bilirubin, glutathione, vitamin E, vitamin C, and carotenoids were associated with a lower risk of CVD. Evidence from the cohort studies in regard to dietary antioxidants also supported the protective effects of dietary vitamin E, vitamin C, carotenoids, and polyphenols on CVD risk. However, results from large randomized controlled trials did not support long-term use of single antioxidant supplements for CVD prevention due to their null or even adverse effects on major cardiovascular events or cancer. Diet quality indexes that consider overall diet quality rather than single nutrients have been drawing increasing attention. Cohort studies and intervention studies that focused on diet patterns such as high total antioxidant capacity have documented protective effects on CVD risk. This review provides a perspective for future studies that investigate antioxidant intake and risk of CVD.
Highlights
Cardiovascular disease (CVD) is the most common cause of death in the Western world and accounts for approximately one third of all deaths around the world
After an 8 year follow-up, total vitamin E intake and vitamin E from supplements were not associated with risk of coronary heart disease (CHD) mortality, but vitamin E from food was inversely associated with CHD mortality, with women in the highest quintile of vitamin E intake having a 62% lower risk (RR: 0.38; 95% confidence interval (CI): 0.18, 0.80) of CHD compared with those in the lowest quintile [64]
Milman et al [91] pointed out that vitamin E supplementation might only benefit subgroups with increased oxidative stress. They conducted a prospective, double-blind, placebo-controlled trial of vitamin E supplementation (400 IU/day) among 1434 men and women of 55 years or older, diabetic and with the Hp 2-2 genotype who were susceptible to oxidative stress, and found vitamin E supplementation of 18 months significantly reduced the primary composite outcome compared with the placebo [91]
Summary
Cardiovascular disease (CVD) is the most common cause of death in the Western world and accounts for approximately one third of all deaths around the world. In the U.S there were more than 80 million deaths due to CVD in 2008, accounting for one third of all deaths. Multiple factors are involved in the cause of CVD, including fixed factors (gene, age, gender), and modifiable factors (diet, smoking, environment, exercise). Formation of an atherosclerotic plaque or lesion is the common phenomenon of all types of CVD. The initiating step in the development of an atherosclerotic lesion is damage to the endothelium [1]. As an important modifiable factor ameliorating CVD risk, is a health target in the public health field. This review focuses on evidence from prospective cohort studies and clinical trials in regard to the associations between plasma/dietary antioxidants and cardiovascular events
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