beta-carotene and Coronary-Disease

Many epidemiological studies have reported that antioxidant vitamin intake from diet or supplements are associated with a lower risk of coronary heart disease (CHD), the findings are, however, inconsistent. We undertook a meta-analysis of cohort studies to examine the relations between antioxidant vitamins (vitamins C, E, and beta-carotene) and CHD risk.. We included all the relevant cohort studies if they provided a relative risk and corresponding 95% confidence interval (CI) of CHD in relation to antioxidant vitamins intake from diet or supplement. Fifteen cohort studies were identified involving a total of 7415 incident CHD cases and 374,488 participants with a median follow-up of approximately 10, 8.5, and 15 years for vitamins C, E, and beta-carotene, respectively. Pooled estimates across studies were obtained by random-effects model. The potential sources of heterogeneity and publication bias were also estimated. For vitamins C, E, and beta-carotene, a comparison of individuals in the top third with those in the bottom third of baseline value yielded a combined relative risk of 0.84 (95% CI, 0.73-0.95), 0.76 (95% CI, 0.63-0.89), and 0.78 (95% CI, 0.53-1.04), respectively. Subgroup analyses show that dietary intake of vitamins C and E and supplement use of vitamin E have an inverse association with CHD risk, but supplement use of vitamin C has no significant association with CHD risk. In the dose-response meta-analysis, each 30 mg/day increase in vitamin C, 30 IU/day increase in vitamin E, and 1 mg/day increase in beta-carotene yielded the estimated overall relative risk for CHD of 1.01 (95% CI, 0.99-1.02), 0.96 (95% CI, 0.94-0.99), and 1.00 (95% CI, 0.88-1.14), respectively.. Our findings in this meta-analysis suggest that an increase in dietary intake of antioxidant vitamins has encouraging prospects for possible CHD prevention.

Topics: Antioxidants; Ascorbic Acid; beta Carotene; Cohort Studies; Coronary Disease; Humans; Incidence; Vitamin E

Lutein and zeaxanthin are xanthophyll carotenoids found particularly in dark-green leafy vegetables and in egg yolks. They are widely distributed in tissues and are the principal carotenoids in the eye lens and macular region of the retina. Epidemiologic studies indicating an inverse relationship between xanthophyll intake or status and both cataract and age-related macular degeneration suggest these compounds can play a protective role in the eye. Some observational studies have also shown these xanthophylls may help reduce the risk of certain types of cancer, particularly those of the breast and lung. Emerging studies suggest as well a potential contribution of lutein and zeaxanthin to the prevention of heart disease and stroke. Even as the evidence for a role of lutein and zeaxanthin in disease prevention continues to evolve, particularly from human studies directed to their bioavailability, metabolism, and dose-response relationships with intermediary biomarkers and clinical outcomes, it is worth noting that recommendations to consume foods rich in xanthophylls are consistent with current dietary guidelines.

Topics: Aging; Anticarcinogenic Agents; beta Carotene; Cataract; Coronary Disease; Humans; Lutein; Macular Degeneration; Neoplasms; Primary Prevention; Stroke; Xanthophylls; Zeaxanthins

Topics: Adult; Aged; alpha-Tocopherol; Antioxidants; Aspirin; beta Carotene; Cardiovascular Diseases; Coronary Disease; Dietary Supplements; Female; Humans; Male; Middle Aged; Randomized Controlled Trials as Topic; Reactive Oxygen Species; Vitamins

Topics: alpha-Tocopherol; Antioxidants; beta Carotene; Chronic Disease; Coronary Disease; Dietary Supplements; Humans; Lung Neoplasms; Risk Factors; Selenium

There is clear evidence of lipoprotein oxidation in atherosclerotic lesions. Animal studies and observational prospective human cohort studies have been interpreted as supporting a role for antioxidants in the prevention of coronary heart disease (CHD). However, firm recommendations to take antioxidant supplements to treat or prevent CHD require evidence derived from randomised controlled studies. In primary prevention studies, low dose alpha-tocopherol does not reduce the incidence of coronary events (ATBC study), and beta-carotene either has no effect or increases the incidence of coronary events and cancer death (ATBC, CARET, Physician's Health studies). Secondary preventions, those with smaller populations and shorter duration of follow up have shown some benefit from alpha-tocopherol (CHAOS, SPACE), but larger randomised studies indicate no benefit from treatment with alpha-tocopherol (HOPE, GISSI, PPP). Recent studies with antioxidant combinations also show no benefit (HATS, MPS). On the basis of these data, supplements of alpha-tocopherol and beta-carotene cannot be recommended for the treatment or prevention of CHD. Fundamental and applied research may yet find a role for antioxidant supplements in the treatment of coronary disease. However, this will require positive results from combined antioxidant studies currently in progress, and the targeting of oxidative processes that operate in the artery wall and cause or contribute to disease.

Topics: Animals; Antioxidants; beta Carotene; Cohort Studies; Coronary Disease; Diet; Dietary Supplements; Female; Humans; Lipid Peroxidation; Male; Prevalence; Randomized Controlled Trials as Topic; Risk Assessment; Sensitivity and Specificity; Vitamin E

Topics: Adult; Aged; Aged, 80 and over; Antioxidants; Ascorbic Acid; beta Carotene; Clinical Trials as Topic; Cohort Studies; Coronary Disease; Dietary Supplements; Female; Humans; Male; Middle Aged; Oxidants; Oxidative Stress; Randomized Controlled Trials as Topic; Reactive Oxygen Species; Vitamin E; Vitamins

The importance of low density lipoprotein (LDL) oxidation to the atherosclerotic process has led to the examination of beta-carotene as a possible preventive agent. Several epidemiologic studies show an inverse association between serum/adipose beta-carotene levels and coronary heart disease risk. Randomized clinical trials, however, have not shown any benefit, and perhaps even an adverse effect, of beta-carotene supplementation. A number of possible confounding factors may explain the inconsistency between the trials and epidemiologic evidence. Other carotenoids that are correlated with beta-carotene both in the diet and in the blood might be important factors, as might other plant-derived compounds. Alternatively, low serum carotenoid levels may reflect either increased lipoprotein density or the presence of inflammation, both factors emerging as important novel risk factors for coronary heart disease. Whereas the trial results support no preventive role for beta-carotene, the epidemiologic evidence does generally support the idea that a diet rich in high carotenoid foods is associated with a reduced risk of heart disease.

Topics: Adipose Tissue; beta Carotene; Carotenoids; Coronary Disease; Diet; Epidemiologic Methods; Humans; Randomized Controlled Trials as Topic

Topics: American Heart Association; Antioxidants; Ascorbic Acid; beta Carotene; Clinical Trials as Topic; Coronary Disease; Diet; Health Personnel; Humans; Risk; Treatment Outcome; Vitamin E

Clinical use of antioxidant vitamin supplementation may help to prevent coronary heart disease (CHD). Epidemiologic studies find lower CHD morbidity and mortality in persons who consume larger quantities of antioxidants in foods or supplements. Clinical trials indicate that supplementation with certain nutrients is beneficial in reducing the incidence of CHD events. Recent studies show that supplementation with antioxidant vitamins E and C have benefits in CHD prevention; however, supplementation with beta-carotene may have deleterious effects and is not recommended. Current evidence suggests that patients with CHD would probably benefit from taking vitamin E in a dosage of 400 IU per day and vitamin C in a dosage of 500 to 1,000 mg per day. Clinicians may also want to consider vitamin supplementation for CHD prevention in high-risk patients. Folate lowers elevated homocysteine levels, but evidence for routine supplemental use does not yet exist. Other nutritional supplements are currently under investigation.

Topics: Antioxidants; Ascorbic Acid; beta Carotene; Coronary Disease; Humans; Patient Education as Topic; Randomized Controlled Trials as Topic; Teaching Materials; Vitamin E; Vitamins

The production of free radicals may favour the processes of atherosclerosis, and antioxidant vitamins (including beta-carotene), which partly prevent such processes, might favorably influence cardiovascular disease (CVD); thus, their supplementation might be a useful tool in the prevention of coronary heart disease (CHD). The relationship between beta-carotene and CHD has been investigated in several observational studies, including ecological, cohort and case-control studies. Six cohort studies reported relative risks (RR) of CHD between 0.27 and 0.78 for high beta-carotene levels (plasma/serum levels and dietary intake), but four more recent ones reported RR around unity (range 0.84 to 1.19). The evidence from case-control studies supports a role of beta-carotene in the prevention of CHD (odds ratios, OR, between 0.37 and 0.71), with a possible stronger protection for current smokers. The four published randomized clinical trials of beta-carotene supplementation found RR close to unity (range 0.96 to 1.26) for the relation between beta-carotene and CHD. The apparent discrepancy between observational and intervention studies may depend on several factors. The benefit reported in some observational studies may be related to consumption of foods rich in beta-carotene rather than beta-carotene itself, as foods rich in beta-carotene are usually rich also in other antioxidant vitamins and micronutrients, or to time-related factors, i.e., longer supplementation in intervention studies. Thus, a reasonable recommendation for the prevention of CHD for the general population is to consume a balanced diet with emphasis on antioxidant rich fruit and vegetables and whole grains.

Topics: beta Carotene; Case-Control Studies; Clinical Trials as Topic; Cohort Studies; Coronary Disease; Humans; Risk

Topics: Ascorbic Acid; beta Carotene; Clinical Trials as Topic; Coronary Disease; Female; Humans; Male; Sri Lanka; Vitamin A; Vitamin E; Vitamins

Topics: beta Carotene; Carotenoids; Coronary Disease; Humans; Immunity; Male; Neoplasms

This review summarizes the scientific evidence for a possible role of antioxidants in the prevention of coronary heart disease (CHD). Dietary antioxidants include vitamin E, vitamin C and beta-carotene, whereas selenium is an integral part of the antioxidant enzyme glutathione peroxidase. Experimental studies suggest that the oxidation of low-density lipoproteins (LDL) in the vessel wall plays an important role in the development of atherosclerotic lesions. The resistance of LDL to oxidation is increased by antioxidant supplementation, at least in vitro. Epidemiological studies have not demonstrated unequivocally that a high intake of antioxidants leads to a decreased risk of CHD. Studies on dietary intake and serum levels of antioxidants do point in the direction of a preventive effect of antioxidants, whereas the results of intervention studies are less conclusive. Beta-carotene supplementation is not associated with any decrease in CHD; high doses of vitamin E may be beneficial, but results from large trials are to be awaited. General preventive measures based on antioxidant supplementation are not yet justifiable.

Topics: Animals; Antioxidants; Ascorbic Acid; beta Carotene; Cardiovascular Diseases; Coronary Disease; Diet; Female; Free Radicals; Humans; Lipoproteins, LDL; Male; Oxidation-Reduction; Prospective Studies; Risk Factors; Selenium; Vitamin E

Evidence is increasing that oxidation of low-density lipoprotein cholesterol may be instrumental in atherogenesis. As a result, a number of studies have been undertaken to evaluate the effects of antioxidant vitamins, beta carotene, selenium, and monounsaturated fat on coronary artery disease. Results in many instances have been promising, particularly in the case of vitamin E supplements. Studies of pro-oxidants, such as iron and copper, are inconclusive at this time, and a trial to assess the value of probucol in hypercholesterolemic patients is currently under way.

Topics: Adult; Aged; Antioxidants; Arteriosclerosis; Ascorbic Acid; beta Carotene; Carotenoids; Cholesterol, LDL; Coronary Disease; Female; Humans; Male; Middle Aged; Randomized Controlled Trials as Topic; Vitamin E

Topics: Antineoplastic Agents; Antioxidants; Ascorbic Acid; beta Carotene; Carotenoids; Coronary Disease; Fruit; Humans; Incidence; Neoplasms; Vegetables; Vitamin E

This review briefly summarizes the scientific evidence for a possible role of antioxidants in the prevention of coronary heart disease (CHD). Antioxidants in our diet include vitamins E, C, and beta-carotene, whereas selenium is an integral part of the antioxidant enzyme glutathione peroxidase (GSHPx). Experimental evidence suggests that free-radical damage and antioxidant defence may play an important role in the development of coronary heart disease. Epidemiological studies have produced some intriguing results, but have not indicated unequivocally that a high intake of antioxidants leads to a decreased cardiovascular disease risk. We conclude that the antioxidant atherosclerosis hypothesis is promising, but that the results of long-term intervention studies are still to be awaited. Preventive action based on antioxidant supplementation is therefore not justifiable as yet. Nevertheless, the findings so far certainly do support the recommendations for a varied diet rich in vegetables and fruit.

Topics: Animals; Antioxidants; Ascorbic Acid; beta Carotene; Carotenoids; Coronary Disease; Diet; Fruit; Humans; Selenium; Vegetables; Vitamin E

Coronary artery disease (CAD) remains by far the leading killer of men and women in the United States, despite a 2% per year decline over the past 2 decades. While CAD becomes the leading cause of death in U.S. women after 60, it becomes so in men after age 40. Heart disease is responsible for one of every three deaths in women as well as men. Thus, any intervention that can reduce CAD risks could have a tremendous public health impact among U.S. adults. Over the past several decades, the atherogenic potential of low density lipoprotein (LDL) cholesterol has been clearly identified. Recent evidence suggests that oxidation of LDL may enhance its atherogenicity, raising the possibility that antioxidant vitamins, which inhibit the oxidation of LDL, may reduce the risk of CAD. Although antioxidants can preserve endothelial function, inhibit platelet aggregability, and reduce atherosclerotic plaque progression in animals, whether supplementation with antioxidant vitamins will reduce the risk of CAD in humans remains unclear. The epidemiologic studies that have explored the antioxidant vitamin hypothesis in humans have included descriptive and cross-sectional studies, analytic investigation using case-control and prospective cohort study designs, as well as a few small trials in secondary prevention. The findings from these studies are not totally consistent, but generally support the hypothesis that antioxidant vitamins may reduce risk of CAD. At present, therefore, antioxidant vitamins represent a promising, but as yet unproven, means to decrease risks of CAD. Several large-scale randomized trials will provide reliable evidence on this question over the next several years. In primary prevention, the recently begun Women's Health Study of 40,000 female health professionals is testing alternate-day doses of beta-carotene (50 mg) and vitamin E (600 mg), and the ongoing Physicians' Health Study of > 22,000 male physicians is also testing a 50 mg combination of beta-carotene, vitamin E, and vitamin C among approximately 8,000 women not eligible for the Women's Health Study due to a prior history of cardiovascular disease. These and other trials will provide reliable, direct evidence concerning the role of antioxidant vitamins in the primary and secondary prevention of cardiovascular disease in women. Such data are crucial both for individual clinical decision making as well as for formulating rational public health policies.

Topics: Antioxidants; Ascorbic Acid; beta Carotene; Carotenoids; Coronary Disease; Female; Humans; Male; Randomized Controlled Trials as Topic; United States; Vitamin E; Vitamins

Topics: beta Carotene; Carotenoids; Coronary Disease; Dietary Fats, Unsaturated; Humans; Malaysia; Neoplasms; Nutritional Physiological Phenomena; Palm Oil; Plant Oils

In order to reduce the lipoprotein-related risk of coronary heart disease, nutritional recommendations have been formulated for use by communities prone to atherosclerosis and its complications. As such recommendations are potentially of widespread application they require careful scrutiny to assess possible risks as well as benefits. Epidemiological, clinical and experimental data concerning relationships between these nutrients and non-cardiovascular diseases are reviewed with emphasis on cancer mortality. Changes in intake of fats, including polyunsaturated fat, of cholesterol, carbohydrate, fibre, sodium and beta-carotene are discussed, and evidence of a relationship between serum cholesterol concentration and cancer is examined. These considerations offer reasonable reassurance as to the safety of recent dietary recommendations for the reduction of coronary heart disease.

Topics: beta Carotene; Carotenoids; Cholesterol, Dietary; Coronary Disease; Dietary Carbohydrates; Dietary Fats; Dietary Fiber; Dose-Response Relationship, Drug; Fatty Acids, Unsaturated; Humans; Life Style; Lipids; Longitudinal Studies; Neoplasms; Risk

To determine whether alpha-tocopherol or beta-carotene supplementation affects diabetic macrovascular complications and total mortality.. This study was carried out as part of the Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study, a double-blind, randomized trial with a 2x2 factorial design. A total of 29,133 middle-aged male smokers received either vitamin E 50 mg/day or beta-carotene 20 mg/day, or both, or placebo for a median of 6.1 years. At base-line, 1700 men had type 2 diabetes. Of these men, 662 were diagnosed with first-ever macrovascular complication, and 1142 died during the 19-year follow-up.. Neither supplementation affected the risk of macrovascular complication or total mortality during the intervention period. For the alpha-tocopherol-supplemented versus no alpha-tocopherol-supplemented, and beta-carotene-supplemented versus no beta-carotene-supplemented we found relative risk (RR) 0.84 (95% confidence interval (CI) 0.65-1.10) and RR 1.15 (95% CI 0.89-1.50) for macrovascular complication, respectively, and RR 1.00 (95% CI 0.80-1.25) and RR 1.06 (95% CI 0.85-1.33) for total mortality, respectively. No essential changes were found in these effects when the follow-up was extended up to 19 years.. Alpha-tocopherol or beta-carotene supplementation has no protective effect on macrovascular outcomes or total mortality of diabetic male smokers.

Topics: Aged; alpha-Tocopherol; beta Carotene; Coronary Disease; Diabetes Mellitus; Diabetic Angiopathies; Double-Blind Method; Finland; Humans; Male; Middle Aged; Peripheral Vascular Diseases; Smoking; Stroke; Survival Rate; Treatment Outcome; Vitamins

The lignan enterolactone produced by the intestinal microflora from dietary precursors has been hypothesized to protect against coronary heart disease. The present study examined the association between serum enterolactone concentration and the risk of coronary heart disease. A prospective case-cohort study was conducted among male smokers randomized to receive a placebo supplement in the Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study (1986-1999). Serum enterolactone concentrations were measured by the gas chromatography-mass spectrometry method in serum collected at trial baseline from 340 men diagnosed with nonfatal myocardial infarction (n = 205) or coronary death (n = 135) during follow-up and from the randomly selected subcohort of 420 subjects. The classic risk factors-adjusted rate ratios for all coronary heart disease events in increasing quintiles of enterolactone were 1.00 (referent), 0.85 (95% confidence interval (CI): 0.51, 1.43), 0.59 (95% CI: 0.35, 1.00), 0.69 (95% CI: 0.40, 1.16), and 0.63 (95% CI: 0.33, 1.11), and the p(trend) was 0.07. For the highest versus the lowest quintile of enterolactone, the rate ratios for nonfatal myocardial infarction and coronary death were 0.67 (95% CI: 0.37, 1.23; p(trend) = 0.10) and 0.57 (95% CI: 0.26, 1.25; p(trend) = 0.18), respectively. In conclusion, only weak support for the association between serum enterolactone concentration and coronary heart disease was found.

Topics: 4-Butyrolactone; Aged; alpha-Tocopherol; beta Carotene; Biomarkers; Case-Control Studies; Coronary Disease; Finland; Humans; Lignans; Male; Middle Aged; Proportional Hazards Models; Prospective Studies; Risk Assessment; Risk Factors; Smoking

Although the ratio of total to high-density lipoprotein cholesterol (TC/HDL) is a powerful predictor of cardiovascular disease (CVD), few studies have investigated which factors are associated with changes in this ratio over time. We examined predictors of a change in TC/HDL ratio over a period of 14 years among 4451 men free of CVD from the Physicians' Health Study.. Baseline and updated physician characteristics and CVD risk factors were included in multivariate linear and logistic regression models to determine factors associated with a change in the TC/HDL ratio or of having a ratio of > or =5 on follow-up.. After a mean follow-up of 14 years, mean total cholesterol decreased by 7 mg/dL, HDL increased by 1 mg/dL, and the ratio decreased by 0.37. In multivariate logistic analyses, physicians were more likely to have a TC/HDL ratio of > or =5 at follow-up if they maintained a weight of > or =25 kg/m2 (OR, 1.69 [1.35-2.12]), gained weight (OR, 2.01 [1.55-2.62]), or became inactive (OR, 1.43 [1.11-1.83]). However, older physicians and those who consumed alcohol or received treatment for hyperlipidemia were more likely to have a ratio of <5.. Although pharmacologic treatment for hyperlipidemia had the greatest favorable impact on the ratio over time, our data also show that maintaining an ideal weight and exercise have beneficial effects. We therefore advocate a renewed fervor for raising public awareness of the benefits of healthy lifestyle behaviors and pharmacologic treatments that are associated with long-term maintenance of favorable cholesterol levels.

Topics: Adult; Aged; Aged, 80 and over; Alcohol Drinking; Aspirin; beta Carotene; Body Weight; Cholesterol; Cholesterol, HDL; Comorbidity; Coronary Disease; Disease Progression; Follow-Up Studies; Humans; Hyperlipidemias; Life Style; Male; Middle Aged; Multivariate Analysis; Physicians; Predictive Value of Tests; Primary Prevention; Risk Factors; Smoking

To evaluate the 6-year post-trial effects of alpha-tocopherol and beta-carotene supplementation on coronary heart disease (CHD) in the alpha-tocopherol, beta-carotene cancer prevention (ATBC) study.. 29,133 male smokers, aged 50-69 years were randomised to receive alpha-tocopherol 50 mg, or beta-carotene 20 mg, or both, or placebo daily for 5-8 years. At the beginning of the post-trial follow-up, 23,144 men were still at risk for a first-ever major coronary event (MCE), and 1255 men with pre-trial history of myocardial infarction (MI) were at risk for MCE. Post-trial risk for MCE (n=2059) was 0.95 (95% confidence interval 0.87-1.04) among alpha-tocopherol recipients compared with non-recipients, and 1.14 (1.04-1.24) among beta-carotene recipients compared with non-recipients. The risk for non-fatal MI (n=993) was 0.96 (0.85-1.09) and 1.16 (1.03-1.32), and for fatal CHD (n=1066) 0.94 (0.83-1.06) and 1.11 (0.99-1.25), respectively. Among men with pre-trial MI no effects were observed in post-trial risk of MCE (n=257).. beta-Carotene seemed to increase the post-trial risk of first-ever non-fatal MI but there is no plausible mechanism to support it. Our findings do not advocate the use of alpha-tocopherol or beta-carotene supplements in prevention of CHD among male smokers.

Topics: Aged; alpha-Tocopherol; Antioxidants; beta Carotene; Coronary Disease; Dietary Supplements; Double-Blind Method; Humans; Male; Middle Aged; Myocardial Infarction; Risk Factors; Smoking; Survival Analysis

To study an antioxidant action of antioxidant vitamins (vitamins C, E and provitamin A) in vitro and in vivo.. The study was made of kinetic parameters of copper-initiated free radical oxidation (FRO) of low density lipoproteins (HDLP) in human blood plasm, antioxidant potential of rat liver and myocardium, the level of FRO products in HDLP and activity of glutathione peroxidase in erythrocytes of 31 males aged 40-64 years with coronary heart disease (CHD).. An antioxidant action of the combinations alpha-tocopherol+ascorbic acid and alpha-tocopherol+beta-carotin was much more potent than that of each of the component alone. The whole complex of the antioxidants completely suppressed FRO of HDLP in the model system. Feeding rats for 30 days with a complex of antioxidant vitamins and selenium produced a sharp enhancement of the antioxidant potential of the liver and a complete suppression of free radical processes in the myocardium. If this complex was given to CHD patients for 2 months, it sharply reduced the amount of FRO primary and secondary products in blood plasm LDLP in growing activity of erythrocytic selenium-containing glutathione peroxidase.. The scheme is proposed for objective experimental assessment of antioxidant efficacy of multicomponent antioxidant medication in laboratory and clinical trials.

Topics: Adult; Animals; Antioxidants; Ascorbic Acid; beta Carotene; Copper; Coronary Disease; Drug Combinations; Free Radicals; Glutathione Peroxidase; Heart; Humans; Lipoproteins, LDL; Liver; Male; Middle Aged; Myocardium; Oxidation-Reduction; Rats; Rats, Wistar; Vitamin E; Vitamins

It has been suggested that increased intake of various antioxidant vitamins reduces the incidence rates of vascular disease, cancer, and other adverse outcomes.. 20,536 UK adults (aged 40-80) with coronary disease, other occlusive arterial disease, or diabetes were randomly allocated to receive antioxidant vitamin supplementation (600 mg vitamin E, 250 mg vitamin C, and 20 mg beta-carotene daily) or matching placebo. Intention-to-treat comparisons of outcome were conducted between all vitamin-allocated and all placebo-allocated participants. An average of 83% of participants in each treatment group remained compliant during the scheduled 5-year treatment period. Allocation to this vitamin regimen approximately doubled the plasma concentration of alpha-tocopherol, increased that of vitamin C by one-third, and quadrupled that of beta-carotene. Primary outcomes were major coronary events (for overall analyses) and fatal or non-fatal vascular events (for subcategory analyses), with subsidiary assessments of cancer and of other major morbidity.. There were no significant differences in all-cause mortality (1446 [14.1%] vitamin-allocated vs 1389 [13.5%] placebo-allocated), or in deaths due to vascular (878 [8.6%] vs 840 [8.2%]) or non-vascular (568 [5.5%] vs 549 [5.3%]) causes. Nor were there any significant differences in the numbers of participants having non-fatal myocardial infarction or coronary death (1063 [10.4%] vs 1047 [10.2%]), non-fatal or fatal stroke (511 [5.0%] vs 518 [5.0%]), or coronary or non-coronary revascularisation (1058 [10.3%] vs 1086 [10.6%]). For the first occurrence of any of these "major vascular events", there were no material differences either overall (2306 [22.5%] vs 2312 [22.5%]; event rate ratio 1.00 [95% CI 0.94-1.06]) or in any of the various subcategories considered. There were no significant effects on cancer incidence or on hospitalisation for any other non-vascular cause.. Among the high-risk individuals that were studied, these antioxidant vitamins appeared to be safe. But, although this regimen increased blood vitamin concentrations substantially, it did not produce any significant reductions in the 5-year mortality from, or incidence of, any type of vascular disease, cancer, or other major outcome.

Topics: Adult; Aged; Aged, 80 and over; Antioxidants; Ascorbic Acid; beta Carotene; Cardiovascular Diseases; Cause of Death; Cholesterol; Coronary Disease; Diabetes Mellitus; Female; Follow-Up Studies; Humans; Male; Middle Aged; Neoplasms; Severity of Illness Index; Stroke; United Kingdom; Vitamin E

Epidemiologic studies have shown a correlation between antioxidant intake and coronary artery disease (CAD); however, the results of clinical trials have been inconsistent. We evaluated the effect of combined antioxidant supplementation on endothelial function and its correlation with change in low-density lipoprotein cholesterol (LDLC) oxidation in patients with established CAD. In a double-blind, placebo-controlled 12-week trial, 18 nonsmoking, nondiabetic patients (mean age 62.4 +/- 8.1 years) were randomized to receive placebo or antioxidant supplementation consisting of (a) 400 IU of vitamin E, 500 mg of vitamin C, and 12 mg of beta-carotene; or (b) 800 IU of vitamin E, 1000 mg of vitamin C, and 24 mg of beta-carotene daily. Endothelial function was evaluated on the basis of percent and absolute changes in brachial artery diameter in response to reactive hyperemia induced by occlusion-release. Baseline and 12-week values of LDL oxidation (measured on the basis of lag phase), endothelial function, dietary composition, serum antioxidants, and lipids were measured. We noted a significant between-group difference at 12 weeks for change in plasma concentrations of alpha-tocopherol, vitamin C, and beta-carotene between the placebo and antioxidant groups (p <.05). Both placebo and treatment groups demonstrated a significant improvement in lag phase; however, the treatment group achieved a greater, although nonsignificant, magnitude of change compared with the placebo group (181.3 +/- 177.8 minutes vs 80.6 +/- 63.0 minutes, P =.06). Within-group change in brachial reactivity from baseline to follow-up in the treatment group did not reach statistical significance (1.7% +/- 3.2% and 0.07 mm +/- 0.13 mm, P =.08 and P =.09, respectively), whereas an improved change in brachial reactivity was observed in the placebo group (2.2% +/- 1.9%, 0.09 mm +/- 0.06 mm, P <.05). No significant correlation was found between change in lag phase and change in endothelial function. On adjustment for confounders, antioxidant supplementation was found not to be a significant predictor of brachial reactivity. We conclude that antioxidant supplementation did not significantly alter brachial reactivity, despite significantly increased plasma levels of antioxidants and improved lag phase. These data should be confirmed in larger-scale trials and examined in studies evaluating individual dietary antioxidant supplementation.

Topics: alpha-Tocopherol; Antioxidants; Ascorbic Acid; beta Carotene; Brachial Artery; Constriction; Coronary Disease; Diet; Dietary Supplements; Double-Blind Method; Endothelium, Vascular; Hemorheology; Humans; Lipid Peroxidation; Lipids; Lipoproteins, LDL; Placebos; Vasodilation; Vitamin E

We sought to prospectively assess whether self-reported periodontal disease is associated with subsequent risk of cardiovascular disease in a large population of male physicians.. Periodontal disease, the result of a complex interplay of bacterial infection and chronic inflammation, has been suggested to be a predictor of cardiovascular disease.. Physicians' Health Study I was a randomized, double-blind, placebo-controlled trial of aspirin and beta-carotene in 22,071 U.S. male physicians. A total of 22,037 physicians provided self-reports of presence or absence of periodontal disease at study entry and were included in this analysis.. A total of 2,653 physicians reported a personal history of periodontal disease at baseline. During an average of 12.3 years of follow-up, there were 797 nonfatal myocardial infarctions, 631 nonfatal strokes and 614 cardiovascular deaths. Thus, for each end point, the study had >90% power to detect a clinically important increased risk of 50%. In Cox proportional hazards regression analysis adjusted for age and treatment assignment, physicians who reported periodontal disease at baseline had slightly elevated, but statistically nonsignificant, relative risks (RR) of nonfatal myocardial infarction, (RR, 1.12; 95% confidence interval [CI], 0.92 to 1.36), nonfatal stroke (RR, 1.10; CI, 0.88 to 1.37) and cardiovascular death (RR, 1.20; CI, 0.97 to 1.49). Relative risk for a combined end point of all important cardiovascular events (first occurrence of nonfatal myocardial infarction, nonfatal stroke or cardiovascular death) was 1.13 (CI, 0.99 to 1.28). After adjustment for other cardiovascular risk factors, RRs were all attenuated and nonsignificant.. These prospective data suggest that self-reported periodontal disease is not an independent predictor of subsequent cardiovascular disease in middle-aged to elderly men.

Topics: Adult; Aged; Aspirin; Bacterial Infections; beta Carotene; Cause of Death; Coronary Disease; Double-Blind Method; Humans; Male; Middle Aged; Periodontitis; Physicians; Prospective Studies; Risk Factors

One strategy for treating coronary artery disease (CAD) patients with low HDL cholesterol (HDL-C) is to maximally increase the HDL-C to LDL-C ratio by combining lifestyle changes with niacin (N) plus a statin. Because HDL can prevent LDL oxidation, the low-HDL state also may benefit clinically from supplemental antioxidants. Lipoprotein changes over 12 months were studied in 153 CAD subjects with low HDL-C randomized to take simvastatin and niacin (S-N), antioxidants (vitamins E and C, beta-carotene, and selenium), S-N plus antioxidants (S-N+A), or placebo. Mean baseline plasma cholesterol, triglyceride, LDL-C, and HDL-C levels of the 153 subjects were 196, 207, 127, and 32 mg/dL, respectively. Without S-N, lipid changes were minor. The S-N and S-N+A groups had comparably significant reductions (P

Topics: Adult; Aged; Antioxidants; Ascorbic Acid; beta Carotene; Cholesterol, HDL; Cholesterol, LDL; Coronary Disease; Dietary Supplements; Drug Interactions; Female; Humans; Hypolipidemic Agents; Male; Middle Aged; Niacin; Particle Size; Selenium; Simvastatin; Vitamin E

Both lipid-modifying therapy and antioxidant vitamins are thought to have benefit in patients with coronary disease. We studied simvastatin-niacin and antioxidant-vitamin therapy, alone and together, for cardiovascular protection in patients with coronary disease and low plasma levels of HDL.. In a three-year, double-blind trial, 160 patients with coronary disease, low HDL cholesterol levels and normal LDL cholesterol levels were randomly assigned to receive one of four regimens: simvastatin plus niacin, vitamins, simvastatin-niacin plus antioxidants; or placebos. The end points were arteriographic evidence of a change in coronary stenosis and the occurrence of a first cardiovascular event (death, myocardial infarction, stroke, or revascularization).. The mean levels of LDL and HDL cholesterol were unaltered in the antioxidant group and the placebo group; these levels changed substantially (by -42 percent and +26 percent, respectively) in the simvastatin-niacin group. The protective increase in HDL2 with simvastatin plus niacin was attenuated by concurrent therapy with antioxidants. The average stenosis progressed by 3.9 percent with placebos, 1.8 percent with antioxidants (P=0.16 for the comparison with the placebo group), and 0.7 percent with simvastatin-niacin plus antioxidants (P=0.004) and regressed by 0.4 percent with simvastatin-niacin alone (P<0.001). The frequency of the clinical end point was 24 percent with placebos; 3 percent with simvastatin-niacin alone; 21 percent in the antioxidant-therapy group; and 14 percent in the simvastatin-niacin-plus-antioxidants group.. Simvastatin plus niacin provides marked clinical and angiographically measurable benefits in patients with coronary disease and low HDL levels. The use of antioxidant vitamins in this setting must be questioned.

Topics: alpha-Tocopherol; Antioxidants; Apolipoproteins; Ascorbic Acid; beta Carotene; Cardiovascular Diseases; Cholesterol, HDL; Cholesterol, LDL; Coronary Angiography; Coronary Disease; Coronary Stenosis; Double-Blind Method; Drug Interactions; Drug Therapy, Combination; Female; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Hypolipidemic Agents; Lipids; Male; Middle Aged; Niacin; Selenium; Simvastatin; Vitamin E

An inverse association between moderate alcohol consumption and coronary heart disease (CHD) has been observed in several epidemiological studies. To assess whether a similar association exists among diabetics, we examined the relation between light to moderate alcohol consumption and CHD in men with and without diabetes mellitus in a prospective cohort study.. A total of 87 938 US physicians (2790 with diagnosed diabetes mellitus) who were invited to participate in the Physicians' Health Study and were free of myocardial infarction, stroke, cancer, or liver disease at baseline were followed for an average of 5.5 years for death with CHD as the underlying cause. During 480 876 person-years of follow-up, 850 deaths caused by CHD were documented: 717 deaths among nondiabetic men and 133 deaths among diabetic men. Among men without diabetes at baseline, the relative risk estimates for those reporting rarely/never, monthly, weekly, and daily alcohol consumption were 1.00 (referent), 1.02, 0. 82, and 0.61 (95% CI 0.49 to 0.78; P for trend <0.0001) after adjustment for age, aspirin use, smoking, physical activity, body mass index, and history of angina, hypertension, and high cholesterol. Among men with diabetes at baseline, the relative risk estimates were 1.00 (referent), 1.11, 0.67, and 0.42 (95% CI 0.23 to 0.77; P for trend=0.0019).. These results suggest that light to moderate alcohol consumption is associated with similar risk reductions in CHD among diabetic and nondiabetic men.

Topics: Alcohol Drinking; Aspirin; beta Carotene; Cardiovascular Diseases; Coronary Disease; Diabetes Mellitus; Double-Blind Method; Humans; Hypercholesterolemia; Hypertension; Longitudinal Studies; Male; Middle Aged; Multivariate Analysis; Neoplasms; Physicians; Platelet Aggregation Inhibitors; Risk Factors

Oxidized low-density lipoprotein is involved in the pathogenesis of atherosclerosis. In epidemiological studies antioxidants have been inversely related with coronary heart disease. Findings from controlled trials are inconclusive.. We studied the primary preventive effect of vitamin E (alpha tocopherol) and beta carotene supplementation on major coronary events in the Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study, a controlled trial undertaken primarily to examine the effects of these agents on cancer. A total of 27 271 Finnish male smokers aged 50 to 69 years with no history of myocardial infarction were randomly assigned to receive vitamin E (50 mg), beta carotene (20 mg), both agents, or placebo daily for 5 to 8 years (median, 6.1 years). The end point was the first major coronary event, either nonfatal myocardial infarction (surviving at least 28 days; n = 1204) or fatal coronary heart disease (n = 907).. The incidence of primary major coronary events decreased 4% (95% confidence interval, -12% to 4%) among recipients of vitamin E and increased 1% (95% confidence interval, -7% to 10%) among recipients of beta carotene compared with the respective nonrecipients. Neither agent affected the incidence of nonfatal myocardial infarction. Supplementation with vitamin E decreased the incidence of fatal coronary heart disease by 8% (95% confidence interval, -19% to 5%), but beta carotene had no effect on this end point.. Supplementation with a small dose of vitamin E has only marginal effect on the incidence of fatal coronary heart disease in male smokers with no history of myocardial infarction, but no influence on nonfatal myocardial infarction. Supplementation with beta carotene has no primary preventive effect on major coronary events.

Topics: Aged; beta Carotene; Cardiovascular Agents; Coronary Disease; Dietary Supplements; Female; Humans; Incidence; Male; Middle Aged; Myocardial Infarction; Risk; Treatment Outcome; Vitamin E

To evaluate the effects of alpha tocopherol and beta carotene supplements on recurrence and progression of angina symptoms, and incidence of major coronary events in men with angina pectoris.. Placebo controlled clinical trial.. The Finnish alpha tocopherol beta carotene cancer prevention study primarily undertaken to examine the effects of alpha tocopherol and beta carotene on cancer.. Male smokers aged 50-69 years who had angina pectoris in the Rose chest pain questionnaire at baseline (n = 1795).. alpha tocopherol (vitamin E) 50 mg/day, beta carotene 20 mg/day or both, or placebo in 2 x 2 factorial design.. Recurrence of angina pectoris at annual follow up visits when the questionnaire was readministered; progression from mild to severe angina; incidence of major coronary events (non-fatal myocardial infarction and fatal coronary heart disease).. There were 2513 recurrences of angina pectoris during follow up (median 4 years). Compared to placebo, the odds ratios for recurrence in the active treatment groups were: alpha tocopherol only 1.06 (95% confidence interval (CI) 0.85 to 1.33), alpha tocopherol and beta carotene 1.02 (0.82 to 1.27), beta carotene only 1.06 (0.84 to 1.33). There were no significant differences in progression to severe angina among the groups given supplements or placebo. Altogether 314 major coronary events were observed during follow up (median 5.5 years) and the risk for them did not differ significantly among the groups given supplements or placebo.. There was no evidence of beneficial effects for alpha tocopherol or beta carotene supplements in male smokers with angina pectoris, indicating no basis for therapeutic or preventive use of these agents in such patients.

Topics: Aged; Angina Pectoris; beta Carotene; Coronary Disease; Double-Blind Method; Follow-Up Studies; Humans; Logistic Models; Male; Middle Aged; Myocardial Infarction; Prognosis; Recurrence; Smoking; Vitamin E

The SUpplementation en VItamines et Minéraux AntioXydants (SU.VI.MAX) Study is a randomized, double-blind, placebo-controlled, primary-prevention trial designed to test the efficacy of daily supplementation with antioxidant vitamins (vitamin C, 120 mg; vitamin E, 30 mg; and beta-carotene, 6 mg) and minerals (selenium, 100 microg; and zinc, 20 mg) at nutrition-level doses (one to three times the daily recommended dietary allowances) in reducing several major health problems in industrialized countries, especially the main causes of premature death, cancers and cardiovascular diseases. The present report describes the design, implementation, and baseline characteristics of participants in this 8-year cohort study, which started in 1994 in France; 12,735 eligible subjects (women aged 35-60, and men aged 45-60) were included in 1994 and will be followed for 8 years. Participants undergo a yearly visit consisting, every other year, of either biological sampling or clinical examination. They also regularly provide information on health events and dietary intake by filling out computerized questionnaires using the Minitel Telematic Network. Data on baseline characteristics of the participants suggest that the present sample is close to the national population in terms of geographic density, socioeconomic status, and the distribution of various major risk factors for the diseases under study. The choice of the study population should allow the results of this trial to apply to adult populations of both sexes in France and other industrialized countries.

Topics: Adult; Ascorbic Acid; beta Carotene; Coronary Disease; Double-Blind Method; Drug Therapy, Combination; Female; France; Humans; Male; Middle Aged; Mortality; Neoplasms; Selenium; Vitamin E; Zinc

Epidemiological data suggest that the intake of antioxidants such as alpha-tocopherol (vitamin E) and beta-carotene has an inverse correlation with the incidence of coronary heart disease. The results from clinical trials of antioxidant supplementation in people with known coronary heart disease are inconclusive.. We studied the frequency of major coronary events in 1862 men enrolled in the alpha-tocopherol beta-carotene Cancer Prevention Study (smokers aged between 50 and 69 years) who had a previous myocardial infarction. In this randomised, double-blind. placebo-controlled study, men had received dietary supplements of alpha-tocopherol (50 mg/day), beta-carotene (20 mg/day), both, or placebo. The median follow-up was 5.3 years. The endpoint of this substudy was the first major coronary event after randomisation. Analyses were by intention to treat.. 424 major coronary events (non-fatal myocardial infarction and fatal coronary heart disease) occurred during follow-up. There were no significant differences in the number of major coronary events between any supplementation group and the placebo group (alpha-tocopherol 94/466; beta-carotene 113/461; alpha-tocopherol and beta-carotene 123/497; placebo 94/438 [log-rank test, p = 0.25]). There were significantly more deaths from fatal coronary heart disease in the beta-carotene (74/461, multivariate-adjusted relative risk 1.75 [95% CI 1.16-2.64], p = 0.007) and combined alpha-tocopherol and beta-carotene groups (67/497, relative risk 1.58 [1.05-2.40], p = 0.03) than in the placebo group (39/438), but there was no significant increase in the alpha-tocopherol supplementation group (54/466, relative risk 1.33 [0.86-2.05], p = 0.20).. The proportion of major coronary events in men with a previous myocardial infarction who smoke was not decreased with either alpha-tocopherol or beta-carotene supplements. In fact, the risk of fatal coronary heart disease increased in the groups that received either beta-carotene or the combination of alpha-tocopherol and beta-carotene; there was a non-significant trend of increased deaths in the alpha-tocopherol group. We do not recommend the use of alpha-tocopherol or beta-carotene supplements in this group of patients.

Topics: Aged; Antioxidants; beta Carotene; Coronary Disease; Double-Blind Method; Finland; Follow-Up Studies; Humans; Male; Middle Aged; Multivariate Analysis; Myocardial Infarction; Placebos; Risk; Smoking; Vitamin E

Oxidizing metabolites generated at the site of coronary angioplasty can induce chain reactions that may lead to restenosis. Antioxidants may counter oxidative stress and modify neointimal formation and vascular remodeling. Experimental data and small clinical studies have suggested that antioxidants may prevent restenosis after angioplasty. In a double-blind, randomized trial, we studied whether drugs with antioxidant properties decrease the incidence and severity of restenosis after angioplasty.. One month before angioplasty, 317 patients were randomly assigned to receive one of four treatments: placebo, probucol (500 mg), multivitamins (30,000 IU of beta carotene, 500 mg of vitamin C, and 700 IU of vitamin E), or both probucol and multivitamins-all given twice daily. Patients were treated for four weeks before and six months after angioplasty. Patients received an extra 1000 mg of probucol, 2000 IU of vitamin E, both probucol and vitamin E, or placebo 12 hours before angioplasty, according to their treatment assignments. Base-line and follow-up angiograms were interpreted by blinded investigators using a quantitative approach.. The mean (+/-SD) reduction in luminal diameter six months after angioplasty was 0.12 +/- 0.41 mm in the probucol group, 0.22 +/- 0.46 mm in the combined-treatment group, 0.33 +/- 0.51 in the multivitamin group, and 0.38 +/- 0.50 mm in the placebo group (P = 0.006 for those receiving vs. those not receiving probucol, and P = 0.70 for those receiving vs. those not receiving vitamins. Restenosis rates per segment were 20.7 percent in the probucol group, 28.9 percent in the combined-treatment group, 40.3 percent in the multivitamin group, and 38.9 percent in the placebo group (P = 0.003 for probucol vs. no probucol). The rates of repeat angioplasty were 11.2 percent. 16.2 percent, 24.4 percent, and 26.6 percent, respectively (P = 0.009 for probucol vs. no probucol).. The antioxidant probucol is effective in reducing the rate of restenosis after balloon coronary angioplasty.

Topics: Angioplasty, Balloon, Coronary; Antioxidants; Ascorbic Acid; beta Carotene; Coronary Angiography; Coronary Disease; Double-Blind Method; Drug Therapy, Combination; Female; Humans; Male; Middle Aged; Probucol; Recurrence; Treatment Outcome; Vitamin E

This study sought to determine the effect of antioxidant supplementation on the susceptibility of low density lipoprotein (LDL) to oxidation in patients with established cardiovascular disease (CVD).. Data are inconsistent regarding the role of antioxidant nutrients in the prevention of CVD.. The study design was a 12-week, double-blind, placebo-controlled clinical trial. Patients with CVD (n = 45) were randomized to 1) placebo control; 2) 400 IU of vitamin E, 500 mg of vitamin C, 12 mg of beta-carotene (mid-dose); or 3) 800 IU of vitamin E, 1,000 mg of vitamin C, 24 mg of beta-carotene (high dose) daily. Reduced susceptibility of LDL to oxidation was estimated by an increase in lag phase (minutes). Baseline and 6- and 12-week measurements of lipoproteins and lag phase were obtained. Plasma levels of antioxidants were measured at baseline and 12 weeks.. Concentrations of alpha-tocopherol, vitamin C and beta-carotene significantly increased in the mid- and high dose groups during the trial. Lag phase significantly increased from baseline (190.1 +/- 63.8 min [mean +/- SD]) to 12 weeks (391.1 +/- 153.0 min) in the high dose group (p < 0.01). A nonsignificant increase in lag phase in the mid-dose group was observed during the same time interval. A dose response was found for mean percent change from baseline to 12 weeks for lag phase for the placebo, mid- and high dose groups (p = 0.004 for trend).. A high dose combination of antioxidant nutrients reduces the susceptibility of LDL to oxidation in patients with CVD and may be useful in secondary prevention.

Topics: Adult; Aged; Aged, 80 and over; Antioxidants; Ascorbic Acid; beta Carotene; Coronary Disease; Double-Blind Method; Female; Food, Fortified; Humans; Lipoproteins, LDL; Male; Middle Aged; Oxidation-Reduction; Vitamin E

Even though dietary fiber has been hypothesized to reduce the risk of coronary heart disease, few large epidemiological studies have examined this relation with good methodology.. The Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study was a randomized, double-blind, placebo-controlled trial with daily supplementation of alpha-tocopherol and/or beta-carotene. Of the participants, 21930 smoking men aged 50 to 69 years who were free of diagnosed cardiovascular disease and had completed a validated dietary questionnaire at baseline were followed for 6.1 years. We monitored the incidence of major coronary events (a combination of first nonfatal myocardial infarction and coronary heart disease death; n = 1399) and mortality from coronary heart disease (n = 635). Both entities had a significant inverse association with dietary fiber, but the association was stronger for coronary death. For men in the highest quintile of total dietary fiber intake (median, 34.8 g/d), the relative risk for coronary death was 0.69 (95% confidence interval, 0.54 to 0.88; P < .001 for trend) compared with men in the lowest quintile of intake (median, 16.1 g/d). With an adjustment for known cardiovascular risk factors, intake of saturated fatty acids, beta-carotene, vitamin C, and vitamin E did not materially change the result. Water-soluble fiber was slightly more strongly associated with reduced coronary death than water-insoluble fiber, and cereal fiber also had a stronger association than vegetable or fruit fiber.. These findings suggest that independent of other risk factors, greater intake of foods rich in fiber can substantially reduce the risk of coronary heart disease, and particularly coronary death, in middle-aged, smoking men.

Topics: Aged; beta Carotene; Cohort Studies; Coronary Disease; Dietary Fiber; Double-Blind Method; Humans; Male; Middle Aged; Neoplasms; Risk Factors; Smoking; Vitamin E

In the Western Electric Company Study, carried out in Chicago, Illinois, data on diet and other factors were obtained in 1958 and 1959 for a cohort of 1,556 employed, middle-aged men. Nutrients included vitamin C and beta-carotene. An index that summarized combined intake of both nutrients was constructed. Mean intakes of vitamin C in the lowest and highest tertiles of the index were 66 and 138 mg/day; corresponding values for beta-carotene were 2.3 and 5.3 mg/day. A total of 522 of 1,556 men died during 32,935 person-years of follow-up, 231 from coronary heart disease and 155 from cancer. After adjustment for potentially confounding factors, relative risks (95% confidence intervals) associated with an increment of 19 points in the index (difference between means of the lowest and highest tertiles) were 0.60 (0.39-0.93) for cancer mortality, 0.70 (0.49-0.98) for coronary disease mortality, and 0.69 (0.55-0.87) for all-cause mortality. These results support the hypothesis that consumption of foods rich in vitamin C and beta-carotene reduces risk of death in middle-aged men.

Topics: Adult; Antioxidants; Ascorbic Acid; beta Carotene; Carotenoids; Chicago; Confidence Intervals; Confounding Factors, Epidemiologic; Coronary Disease; Diet; Humans; Male; Middle Aged; Mortality; Neoplasms; Pilot Projects; Risk Factors; Telephone

Topics: Antioxidants; beta Carotene; Carotenoids; Coronary Disease; Humans; Lung Neoplasms; Male; Prostatic Neoplasms; Vitamin E

An inverse association between height and risk of coronary heart disease (CHD) has been reported in several case-control and cohort studies, but the reasons for the association remain uncertain. We evaluated this association among 22,071 male physicians, a population homogeneous for high educational attainment and socioeconomic status in adulthood.. The study population was comprised of participants in the Physicians' Health Study, a randomized, double-blind, placebo-controlled trial of low-dose aspirin and beta-carotene in the primary prevention of cardiovascular disease and cancer among US male physicians, aged 40 to 84 years, in 1982. Participants were classified into five height categories at study entry, from shortest to tallest, and were followed an average of 60.2 months to determine the incidence of myocardial infarction (MI), stroke, and death from cardiovascular disease. Men in the tallest (> or = 73 in. or 185.4 cm) compared with the shortest (< or = 67 in. or 170.2 cm) height category had a 35% lower risk of MI (relative risk, 0.65; 95% confidence interval, 0.44 to 0.99; P = .04), after adjusting for known cardiovascular risk factors. Further, a marginally significant inverse trend (P trend = .05) across the height categories was observed. Although the relationship was not strictly linear, for every inch of added height, there was an approximate 2% to 3% decline in risk of MI. In contrast, men in the tallest compared with the shortest height category had only small and nonsignificant decreases in risk of stroke and cardiovascular death. While no significant trend in risks of these end points across the height categories was observed, the numbers of events for these end points were far less than for MI, and thus the confidence intervals were wide.. These data indicate that height is inversely associated with subsequent risk of MI. At this time, a few mechanisms are plausible, but none are convincing. Other epidemiological and basic research efforts are needed to explore a variety of physiological correlates of height that may be responsible for mediating the height-MI association. In the meantime, while height is not modifiable, it is easy to measure and may be useful to evaluate CHD disease risk profiles and target lifestyle interventions.

Topics: Adjuvants, Immunologic; Aspirin; beta Carotene; Body Height; Carotenoids; Cohort Studies; Coronary Disease; Double-Blind Method; Humans; Incidence; Male; Middle Aged; Physicians; Prospective Studies; Risk Factors

Dietary guidelines recommend increasing fruit and vegetable intake and, most recently, have also suggested increasing variety.. We prospectively examined the independent roles of quantity and variety in fruit and vegetable intake in relation to incident coronary heart disease (CHD).. We prospectively followed 71,141 women from the Nurses' Health Study (1984-2008) and 42,135 men from the Health Professionals Follow-Up Study (1986-2008) who were free of diabetes, cardiovascular diseases, and cancer at baseline. Diet was assessed by using a validated questionnaire and updated every 4 y. Variety was defined as the number of unique fruit and vegetables consumed at least once per week. Potatoes, legumes, and fruit juices were not included in our definition of fruit and vegetables.. During follow-up, we documented 2582 CHD cases in women and 3607 cases in men. In multivariable analyses, after adjustment for dietary and nondietary covariates, those in the highest quintile of fruit and vegetable intake had a 17% lower risk (95% CI: 9%, 24%) of CHD. A higher consumption of citrus fruit, green leafy vegetables, and β-carotene- and vitamin C-rich fruit and vegetables was associated with a lower CHD risk. Conversely, quantity-adjusted variety was not associated with CHD.. Our data suggest that absolute quantity, rather than variety, in fruit and vegetable intake is associated with a significantly lower risk of CHD. Nevertheless, consumption of specific fruit and vegetable subgroups was associated with a lower CHD risk.

Topics: Adult; Aged; Ascorbic Acid; beta Carotene; Citrus; Cohort Studies; Coronary Disease; Diet; Feeding Behavior; Female; Follow-Up Studies; Fruit; Health Personnel; Humans; Male; Middle Aged; Nurses; Plant Leaves; Prospective Studies; Risk Factors; United States; Vegetables

Intake of marine-based n-3 fatty acids (EPA, docosapentaenoic acid and DHA) is recommended to prevent CHD. Stearidonic acid (SDA), a plant-based n-3 fatty acid, is a precursor of EPA and may be more readily converted to EPA than a-linolenic acid (ALA). While transgenic soyabeans might supply SDA at low cost, it is unclear whether SDA is associated with CHD risk. Furthermore, associations of other n-3 fatty acids with CHD risk remain inconsistent. The present ancillary study examined the association of erythrocyte SDA as well as other n-3 fatty acids with the risk of CHD. In a prospective nested case-control study of the Physicians' Health Study, we randomly selected 1000 pairs of incident CHD with matching controls. Erythrocyte fatty acids were measured using GC. We used conditional logistic regression to estimate relative risks. Mean age was 68·7 (SD 8·7) years. In a multivariable model controlling for matching factors and established CHD risk factors, OR for CHD for each standard deviation increase of log-SDA was 1·03 (95% CI 0·90, 1·18). Corresponding values for log-ALA and log-marine n-3 fatty acids were 1·04 (95% CI 0·94, 1·16) and 0·97 (95% CI 0·88, 1·07), respectively. In conclusion, the present data did not show an association among erythrocyte SDA, ALA or marine n-3 fatty acids and the risk of CHD in male physicians.

Topics: Aged; Aging; Aspirin; beta Carotene; Case-Control Studies; Coronary Disease; Double-Blind Method; Erythrocytes; Fatty Acids, Omega-3; Humans; Macular Degeneration; Male; Middle Aged; Neoplasms; Risk Factors; Vitamins

Topics: Adult; Aged; Ascorbic Acid; Asthma; beta Carotene; Clinical Trials as Topic; Clinical Trials, Phase I as Topic; Coronary Disease; Disease; Disease Susceptibility; Epidemiologic Factors; Female; Heart Transplantation; Humans; Incidence; Male; Men; Middle Aged; Neoplasms; Pregnancy; Prognosis; Pulmonary Disease, Chronic Obstructive; Risk Factors; Sex Factors

Studies of the desaturation of saturated fatty acids in animals may help explain conflicting reports of the response of coronary heart disease (CHD) to beta-carotene in humans. A negative relationship exists between desaturation and adipose beta-carotene in cattle when they consume different quantities of beta-carotene. Opposing this finding, however, is a positive relationship between desaturation and adipose beta-carotene when cattle are fed the same quantity of beta-carotene. The reason for this apparent contradiction appears to be due to differences in consumption, or variability in the metabolism of beta-carotene. Animals that efficiently metabolize beta-carotene to vitamin A have low desaturation but high antioxidant potential. These results in animals show some similarity between the consumption of the antioxidant beta-carotene and the risk of coronary heart disease where the oxidation of low-density lipoproteins (LDL) is believed to play a role in the development of atherosclerotic plaque. Genetic differences in carotenoid metabolism in humans, similar to those in animals, would assist in explaining differences in lipoprotein oxidation in humans and variation in the risk of coronary heart disease.

Topics: Adipose Tissue; Animal Feed; Animals; Antioxidants; beta Carotene; Cattle; Coronary Disease; Fatty Acids; Humans; Lipoproteins; Models, Biological; Models, Theoretical; Oxygen; Vitamin A

Fruit and vegetable consumption is associated with low CHD risk in the USA and Northern Europe. There is, in contrast, little information about these associations in other regions of Europe. The goal of the present study was to assess the relationship between frequency of fruit and vegetable intake and CHD risk in two European populations with contrasting cardiovascular incidence rates; France and Northern Ireland. The present prospective study was in men aged 50-59 years, free of CHD, who were recruited in France (n 5982) and Northern Ireland (n 2105). Fruit and vegetable intake was assessed by a food-frequency questionnaire. Incident cases of acute coronary events and angina were recorded over a 5-year follow-up. During follow-up there was a total of 249 ischaemic events. After adjustment on education level, smoking, physical activity, alcohol consumption, employment status, BMI, blood pressure, serum total and HDL-cholesterol, the relative risks (RR) of acute coronary events were 0.67 (95% CI 0.44, 1.03) and 0.64 (95% CI 0.41, 0.99) in the 2nd and 3rd tertiles of citrus fruit consumption, respectively (P for trend <0.03). Similar results were observed in France and Northern Ireland. In contrast, the RR of acute coronary events for 'other fruit' consumption were 0.70 (95% CI 0.31, 1.56) and 0.52 (95% CI 0.24, 1.14) respectively in Northern Ireland (trend P<0.05) and 1.29 (95% CI 0.69, 2.4) and 1.15 (95% CI 0.68, 1.94) in France (trend P=0.5; interaction P<0.04). There was no evidence for any association between vegetable intake and total CHD events. In conclusion, frequency of citrus fruit, but not other fruits, intake is associated with lower rates of acute coronary events in both France and Northern Ireland, suggesting that geographical or related factors might affect the relationship between fruit consumption and CHD risk.

Topics: Acute Disease; Anticarcinogenic Agents; Ascorbic Acid; beta Carotene; Citrus; Coronary Disease; Cryptoxanthins; Diet; Eating; France; Fruit; Humans; Incidence; Life Style; Male; Middle Aged; Northern Ireland; Prospective Studies; Risk Factors; Vegetables; Xanthophylls

In 1995, middle-aged Lithuanian men had a four-fold higher risk than Swedish men of dying from coronary heart disease. The cross-sectional LiVicordia study had reported significantly lower levels of the lipid-soluble antioxidants lycopene, beta-carotene, and gamma-tocopherol among Lithuanian men than among Swedish men. We examined whether there were differences in urinary 8-hydroxydeoxyguanosine (8OHdG), a marker of oxidative stress, between these groups of men.. Using automated coupled column high-performance liquid chromatography with electrochemical detection, we examined 50-y-old men randomly sampled from Linköping, Sweden (n = 99) and Vilnius, Lithuania (n = 109) with regard to urinary concentrations of 8-OHdG.. Levels of 8-OHdG were higher in the Lithuanian men than in the Swedish men (20.9 +/- 0.91 versus 14.9 +/- 0.75 nM/L, P < 0.001), and this difference was evident in smokers (P < 0.01) and non-smokers (P < 0.001). Serum levels of alpha- and beta-carotene were inversely correlated to urinary 8-OHdG levels (P < 0.05 in both cases). Habitual smoking and low levels of beta-carotene contributed significantly to higher oxidative DNA damage expressed as urinary 8-OHdG.. These findings indicate that increased urinary 8-OHdG levels accompany lower serum levels of antioxidants in Lithuanian men. They supported previous suggestions that increased oxidative stress may be one factor behind the higher mortality in Lithuanian men.

Topics: 8-Hydroxy-2'-Deoxyguanosine; Antioxidants; beta Carotene; Biomarkers; Chromatography, High Pressure Liquid; Coronary Disease; Cross-Sectional Studies; Deoxyguanosine; DNA Adducts; DNA Damage; Humans; Lithuania; Male; Middle Aged; Oxidative Stress; Random Allocation; Risk Factors; Smoking; Sweden

Numerous studies have shown that higher intakes or higher blood concentrations of carotenes are associated with a lower risk of coronary artery disease (CAD). Given the null results in trials of beta-carotene supplementation, considerable attention has focused on the potential role of other dietary carotenoids in the prevention of CAD.. Our objective was to prospectively examine the relation between dietary intakes of specific carotenoids and risk of CAD in women.. In 1984, 73 286 female nurses completed a semiquantitative food-frequency questionnaire that assessed their consumption of carotenoids and various other nutrients. The women were followed for 12 y for the development of incident CAD (nonfatal myocardial infarction and fatal CAD), and dietary information was updated in 1986, 1990, and 1994.. During 12 y of follow-up (803 590 person-years), we identified 998 incident cases of CAD. After adjustment for age, smoking, and other CAD risk factors, we observed modest but significant inverse associations between the highest quintiles of intake of beta-carotene and alpha-carotene and risk of CAD but no significant relation with intakes of lutein/zeaxanthin, lycopene, or beta-cryptoxanthin. For women in the highest compared with the respective lowest quintile of intake, the relative risks for beta-carotene and alpha-carotene were 0.74 (95% CI: 0.59, 0.93) and 0.80 (95% CI: 0.65, 0.99), respectively. The association between the specific carotenoids and CAD risk did not vary significantly by current smoking status.. Higher intakes of foods rich in alpha-carotene or beta-carotene are associated with a reduction in risk of CAD.

Topics: Adult; Antioxidants; beta Carotene; Carotenoids; Coronary Disease; Diet; Dose-Response Relationship, Drug; Female; Follow-Up Studies; Humans; Middle Aged; Prospective Studies; Risk

Low serum levels of antioxidant vitamins are associated with coronary artery disease (CAD). An immunomodulatory effect of antioxidants has been proposed. The aim of the study was to investigate whether an increased immune response in CAD patients was associated with suppressed circulating levels of antioxidant vitamins.. Forty-four men with stable angina and angiographically verified CAD were included as well as 69 healthy controls. T cell subsets in peripheral blood were quantified by 3-colour flow cytometry. C-reactive protein (CRP), soluble interleukin-2 receptor (sIL-2R) and the lipophilic antioxidants alpha-tocopherol, beta-carotene and lycopene were determined in serum. Compared with controls, patients had signs of an enhanced inflammatory activity assessed by significantly increased levels of CRP, sIL-2R and CD4+CD25+T cell subsets. Patients also had significantly lower beta-carotene and lycopene levels whereas a-tocopherol levels did not differ. The increased inflammatory/immune parameters in patients showed a significant inverse relationship to serum beta-carotene but not to lycopene or alpha-tocopherol.. Low serum beta-carotene in CAD patients reflects activation of the immune system. Inflammation should be considered as an important confounding factor when analysing data on beta-carotene and CAD.

Topics: alpha-Tocopherol; Antioxidants; beta Carotene; C-Reactive Protein; Carotenoids; Case-Control Studies; Coronary Disease; Flow Cytometry; Humans; Lycopene; Male; Middle Aged; Receptors, Interleukin-2; T-Lymphocyte Subsets

Lithuanian middle-aged men have a fourfold higher risk for coronary heart disease (CHD) mortality compared with Swedish men. In Sweden, CHD mortality is twice as high in blue- compared with white-collar workers. Whether the same risk factors that characterized Lithuanian men, compared with Swedish men, could be found in low socioeconomic groups within the cities was investigated.. The LiVicordia study compared both traditional and new possible risk factors for CHD among 150 50-year-old men in Linköping, Sweden and Vilnius, Lithuania. A comparison was made of the prevalence of these risk factors in high and low socioeconomic groups within the cities and, after controlling for the city, variations across socioeconomic groups in the total sample.. Small differences were found in traditional risk factors between cities. However, Vilnius men were shorter, had lower serum levels of antioxidant vitamins, more psychosocial strain, and lower cortisol response to a standardized laboratory stress test. These characteristics were also found among men in low social classes in both cities. In linear regression models, short stature, low serum beta-carotene, low social integration, coping and self-esteem, high vital exhaustion, high baseline and low cortisol response to stress were related to low social class.. The same set of risk factors, mainly relating to oxidative and psychosocial stress, that characterized Vilnius men was also found in men in low social classes within the cities. The results suggest that a common set of risk factors may help to explain health differences both between and within countries.

Topics: Antioxidants; beta Carotene; Coronary Disease; Employment; Humans; Hydrocortisone; Lithuania; Male; Middle Aged; Oxidative Stress; Risk Factors; Social Class; Socioeconomic Factors; Stress, Psychological; Sweden; Urban Health

Hyperhomocysteinemia is an important cardiovascular risk factor. Serum homocysteine levels are specially dependent on folate nutritional status. In addition, the oxidative modification of low-density lipoproteins (LDLs) in the endothelial microenvironment is a damaging factor that can be modified with fat-soluble antioxidant vitamins. The present study was done to assess the effect of a supplementation of folic acid and antioxidant vitamins on homocysteine levels and in vitro LDL oxidation in patients with coronary artery disease. Twenty-three patients with angiographically proven coronary artery disease were given supplements for 15 d consisting of one capsule twice a day of a multivitamin preparation containing 0.65 mg folic acid, 150 mg alpha-tocopherol, 150 mg ascorbic acid, 12.5 mg beta-carotene, and 0.4 microgram vitamin B12. Serum lipids, vitamin and homocysteine levels, and in vitro LDL oxidation were measured before and after the supplementation period. During the supplementation period, serum folate levels increased from 5.0 +/- 1.5 to 10.8 +/- 3.8 ng/mL (P < 0.001), vitamin B12 increased from 317.4 +/- 130.4 to 334.5 +/- 123.8 pg/mL (P < 0.05), and alpha-tocopherol increased from 8.2 +/- 5.1 to 13.7 +/- 7.9 mg/L (P < 0.001). Serum homocysteine levels decreased from 8.7 +/- 4.3 to 6.3 +/- 2.2 mumol/L (P < 0.001). In vitro LDL oxidation decreased from 2.6 +/- 1.1 to 1.6 +/- 1.1 nmol malondialdehyde/mg protein (P < 0.001). In comparing patients with healthy controls, basal levels of folate were lower in the patients, whereas vitamin B12, alpha-tocopherol, and homocysteine levels were similar. No changes in serum lipid levels or body weight were observed. In conclusion, a short-term supplementation with folic acid and antioxidant vitamins can reduce serum homocysteine levels and in vitro LDL oxidation in patients with coronary artery disease.

Topics: Antioxidants; Ascorbic Acid; beta Carotene; Coronary Disease; Dietary Supplements; Folic Acid; Homocysteine; Humans; Lipid Peroxidation; Lipids; Lipoproteins, LDL; Vitamin B 12; Vitamin E; Vitamins

High affinity IgG autoantibodies against oxidized low density lipoproteins (oxLDLs), apolipoprotein B and lipid-soluble antioxidants--alpha-tocopherol and beta-carotene, were tested in patients with coronary heart disease. Correlation relationships between these parameters were analysed. Fifty one patients with coronary heart disease (37 males/14 females) defined as Q-wave myocardial infarction and/or stenosis of more than 50%, and 51 healthy blood donors (34 males/17 females) as controls participated in this study. LDLs were isolated by density gradient ultracentrifugation and oxidized with Cu2+. OxLDLs or native LDLs (nLDLs) were used as antigens in enzyme immunoassay (ELISA) to detect IgG autoantibodies in the serum. The contents of alpha-tocopherol and beta-carotene were measured by HPLC. Apolipoprotein B was determined by immunoturbidimetry. Correlation analysis of the parameters was carried out by Spearmann's test. Alpha-tocopherol was decreased significantly in the serum of patients with coronary heart disease (2.96+/-1.63 nmol/mg serum protein vs 6.23+/-2.28 nmol/mg serum protein in Control group) (p < 0.01). Also, the serum level of beta-carotene was decreased in patients with coronary heart disease (174.0+/-95.7 pmol/mg serum protein vs 313.2+/-141.5 pmol/mg serum protein in Control group) (p < 0.01), while apolipoprotein B was increased significantly (1.20+/-0.34 g/l in patients with coronary heart disease vs 0.86+/-0.23 g/l in Control group) (p < 0.001). In a previous study we established that the mean serum level of IgG autoantibodies against oxLDLs (expressed in optical density units) was about 2.5 times higher in patients with coronary heart disease as compared to control subjects (p < 0.001). A good positive linear correlation was observed between alpha-tocopherol and apolipoprotein B levels in Control group (r = 0.78, p < 0.001), as well as in the group of patients with coronary heart disease (r = 0.42, p < 0.001). Poor nonsignificant correlations were established between all another measured parameters. In conclusion, the lipid-soluble antioxidants--alpha-tocopherol and beta-carotene, are not informative with respect to the susceptibility of the serum to oxidative modifications and as to the extent of the subsequent humoral immune response. Presumably, the reduction of the correlation coefficient between apolipoprotein-B and alpha-tocopherol in patients with coronary heart disease in comparison with control subjects could provide indirec

Topics: Adult; Aged; Antioxidants; Apolipoproteins B; Autoantibodies; beta Carotene; Case-Control Studies; Centrifugation, Density Gradient; Coronary Disease; Enzyme-Linked Immunosorbent Assay; Female; Humans; Immunoglobulin G; Linear Models; Lipoproteins, LDL; Male; Middle Aged; Vitamin E

Environmental tobacco smoke (ETS) is a pervasive contaminant in the workplace. Our objective was to determine the oxidative stress effects of ETS on employees who are exposed. The results provide information that is useful to the resolution of risk assessment questions associated with ETS. We analyzed two blood draws from volunteers in our control and exposed groups. The level of exposure to ETS was determined through plasma cotinine measurements, which showed a 65% increase from the control group to the exposed group. Exposure to ETS resulted in a statistically significant increase of 63% of the oxidative DNA mutagen 8-hydroxy-2'-deoxyguanosine in the blood of exposed subjects. This oxidative DNA damage has been linked to an increased risk of developing several degenerative chronic diseases, including coronary heart disease and cancer. The exposed subjects also had increased levels of superoxide dismutase, catalase, glutathione peroxidase (GPOX), and glutathione reductase. However, these increases were only statistically significant in catalase and GPOX. Catalase levels were 13% higher in the exposed group, and GPOX levels were 37% higher in exposed volunteers. The biochemical evidence suggests that exposure to ETS causes oxidative stress, resulting in DNA damage that may increase the risk of certain diseases.

Topics: 8-Hydroxy-2'-Deoxyguanosine; Adult; Air Pollution, Indoor; Ascorbic Acid; beta Carotene; Catalase; Coronary Disease; Cotinine; Deoxyguanosine; Female; Glutathione Reductase; Humans; Male; Middle Aged; Neoplasms; Oxidative Stress; Risk Factors; Superoxide Dismutase; Tobacco Smoke Pollution; Vitamin E; Workplace

To compare plasma levels of antioxidant vitamins in the Czech population with those in a western European population, and to investigate whether plasma levels of antioxidant vitamins in Czech population are related to risk of MI.. The study has two parts: a cross-sectional survey and a population based case-control study.. Adult population in two districts of the Czech Republic, and London based civil servants group as the comparison.. A random sample of men and women aged 25-64y resident in two districts were selected for the cross- sectional survey. Subjects in the age group 40-49 y were compared to a sample of British civil servants of the same age enrolled in the Whitehall II Study. Men in the Czech sample served as controls to 52 male cases of first non-fatal myocardial infarction (MI) which occurred in the same population. Plasma samples were obtained from venepuncture during an interview in hospital in the population sample and immediately after hospitalization in the MI cases.. Plasma levels of beta-carotene and alpha-tocopherol, and the event of MI. Identical protocol and one laboratory was used for all analyses.. The mean plasma levels of beta-carotene and alpha-tocopherol in healthy Czech men and women were substantially lower than in a subsample of British civil servants examined in the same laboratory. Smoking was strongly related to beta-carotene in both populations but differences between Czechs and Brits were present in both smokers and non-smokers. In the case-control study among Czech men, low levels of the vitamins were strongly related to an increases risk of MI. Age-adjusted odds ratios for concentrations below the median were 3.33 (95% confidence interval 1.43-8.33) for beta-carotene and 1.89 (0.94-3.45) for alpha-tocopherol; further adjustment for a range of variables reduced these estimates only slightly.. Plasma concentrations of antioxidants in the Czech population appeared to be very low, and men with low levels of these substances are at increased risk of MI. This indicates that sub-optimal intake of antioxidants or related dietary factors may have played a role in the high rates of coronary heart disease in this population.

Topics: Adult; Antioxidants; beta Carotene; Case-Control Studies; Coronary Disease; Cross-Sectional Studies; Czech Republic; Female; Humans; Male; Middle Aged; Multivariate Analysis; Smoking; United Kingdom; Vitamin E

Topics: Antioxidants; Arteriosclerosis; Ascorbic Acid; beta Carotene; Coronary Disease; Humans; Neoplasms; Risk Factors; Treatment Outcome; Vitamin E

The Food and Drug Administration (FDA) is issuing an interim final rule to prohibit the use on foods of a claim relating to the relationship between antioxidant vitamins A and beta-carotene and the risk in adults of atherosclerosis, coronary heart disease, amd certain cancers. This interim final rule is in response to a notification of a health claim submitted under section 303 of the FDA Modernization Act of 1997 (FDAMA). FDA has reviewed statements that the petitioner submitted in that notification, and, in conformity with the requirements of FDAMA, the agency is prohibiting the claim because the statements submitted as the basis of the claim are not "authoritative statements" of a scientific body, as required by FDAMA; therefore, section 303 of FDAMA does not authorize use of this claim. As provided for in section 301 of FDAMA, this interim final rule is effective immediately upon publication.

Topics: Adult; Arteriosclerosis; beta Carotene; Coronary Disease; Drug Approval; Food Labeling; Humans; Neoplasms; Risk Factors; United States; United States Food and Drug Administration; Vitamin A

The relation of intakes of specific fatty acids and the risk of coronary heart disease was examined in a cohort of 21,930 smoking men aged 50-69 years who were initially free of diagnosed cardiovascular disease. All men participated in the Finnish Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study and completed a detailed and validated dietary questionnaire at baseline. After 6.1 years of follow-up from 1985-1988, the authors documented 1,399 major coronary events and 635 coronary deaths. After controlling for age, supplement group, several coronary risk factors, total energy, and fiber intake, the authors observed a significant positive association between the intake of trans-fatty acids and the risk of coronary death. For men in the top quintile of trans-fatty acid intake (median = 6.2 g/day), the multivariate relative risk of coronary death was 1.39 (95% confidence interval (CI) 1.09-1.78) (p for trend = 0.004) as compared with men in the lowest quintile of intake (median = 1.3 g/day). The intake of omega-3 fatty acids from fish was also directly related to the risk of coronary death in the multivariate model adjusting also for trans-saturated and cis-monounsaturated fatty acids (relative risk (RR) = 1.30, 95% CI 1.01-1.67) (p for trend = 0.06 for men in the highest quintile of intake compared with the lowest). There was no association between intakes of saturated or cis-monounsaturated fatty acids, linoleic or linolenic acid, or dietary cholesterol and the risk of coronary deaths. All the associations were similar but somewhat weaker for all major coronary events.

Topics: Aged; beta Carotene; Coronary Disease; Diet Surveys; Dietary Fats; Energy Intake; Fatty Acids; Finland; Follow-Up Studies; Humans; Male; Middle Aged; Multivariate Analysis; Risk Factors; Surveys and Questionnaires; Vitamin E

Topics: Administration, Oral; Aged; Aged, 80 and over; Ascorbic Acid; beta Carotene; Chromatography, High Pressure Liquid; Coronary Disease; Diet; Eating; Female; Humans; Male; Middle Aged; Multivariate Analysis; Vitamin E

Topics: Antioxidants; beta Carotene; Coronary Disease; Evidence-Based Medicine; Humans; Lipoproteins, LDL; Myocardial Infarction; Vitamin E

Topics: beta Carotene; Coronary Disease; Drug Interactions; Ethanol; Finland; Humans; Lung Neoplasms; Myocardial Infarction; Smoking

Topics: Antioxidants; Aspirin; beta Carotene; Coronary Disease; Humans; Vitamin E

Plasma alpha-tocopherol, beta-carotene, serum lipids and their derived ratios were determined in British Civil Servants (n = 7177) at the second medical examination of the Whitehall II Study, a longitudinal study of cardiovascular disease. For plasma alpha-tocopherol the non-parametric 95% reference interval (90% confidence limits) for the total population was: 11.1 (10.9-11.3)-51.5 (50.6-52.7) mumol/l. For plasma beta-carotene the non-parametric reference interval for the total population was: 0.05 (0.05-0.05)-2.14 (2.08-2.21) mumol/l. The latter interval was wider than those previously published with a higher mean (0.61 mumol/l) and median (0.75 mumol/l). Plasma beta-carotene concentrations were higher in women than men with age-adjusted means of 0.70 and 0.57 mumol/l respectively (p < 0.001). This may reflect differences in diet, lifestyle and metabolism between the sexes. The alpha-tocopherol/cholesterol ratio, as in other surveys, did not vary with age. Among men, current- and ex-smokers had a higher alpha-tocopherol/cholesterol ratio than never-smokers with age-adjusted means of 4.18, 4.19 mumol/mmol and 4.05 mumol/mmol respectively. This difference is as yet unexplained. Follow-up of these subjects will help to clarify the role of antioxidant nutrients as protective factors for cardiovascular disease and cancer.

Topics: Adult; Age Factors; beta Carotene; Cholesterol; Chromatography, High Pressure Liquid; Cohort Studies; Coronary Disease; Diet; Female; Humans; Life Style; Longitudinal Studies; Male; Middle Aged; Reference Values; Sex Characteristics; Smoking; Spectrophotometry, Ultraviolet; Statistics, Nonparametric; United Kingdom; Vitamin E

Topics: beta Carotene; Carotenoids; Coronary Disease; Diet; Flavonoids; Humans

High intakes of antioxidants in fruit, vegetables and wine are thought to protect against coronary heart disease (CHD). Because people in Toulouse have a much lower incidence of CHD compared with Belfast, the plasma concentrations of antioxidant vitamins and carotenoids in the two populations have been compared. The major difference was in some of the plasma carotenoids. Hydroxy-carotenoids were twice as high in Toulouse in both sexes, notably lutein which occurs principally in dark green vegetables and beta-cryptoxanthin which occurs chiefly in citrus fruits. In addition, alpha-carotene was 50% higher in Toulouse, gamma-tocopherol was 50% higher in Belfast. Other plasma vitamins and carotenoids were not significantly different. If antioxidants play a role in preventing CHD, then the hydroxy-carotenoids are major candidates for further investigation.

Topics: Aged; Alcohol Drinking; Antioxidants; beta Carotene; Blood Chemical Analysis; Body Mass Index; Carotenoids; Coronary Disease; Cryptoxanthins; Eating; Female; France; Humans; Lipids; Lipoproteins; Lutein; Male; Middle Aged; Northern Ireland; Risk Factors; Smoking; Vitamins; World Health Organization; Xanthophylls

With the changes in trends of disease pattern from infectious to chronic degenerative disease, cardiovascular disease has been considered as the major cause of death in Korea. Numerous studies have been done on the antioxidant effects of some vitamins in the prevention of chronic illness, but not many in relation to the cardiovascular disease. Therefore, the relation between antioxidant vitamins, mainly alpha-tocopherol (alpha-T) and beta-carotene (beta-C), and coronary artery disease (CAD) such as angina pectoris and myocardial infarction has been investigated in this study. The blood samples were obtained from the CAD patients who were angiographically diagnosed within a month (100 case group). Patients who had an experience of PTCA or CABG were excluded from the study. Control subjects were healthy adults who had normal EKG values, no chest pain and no past history of cardiac disease (100 control group). All subjects were free for serum lipid lowering drugs. Serum alpha-T and beta-C were analysed using HPLC. In addition to antioxidant vitamins, serum lipids (total cholesterol, HDL, TG) were also measured. Each case and control was matched in terms of age and sex. And all the CAD risk factors such as blood pressure, smoking, alcohol, serum lipid profile and BMI were adjusted to determine pure effect(s) of alpha-T and beta-C on the CAD. The concentrations of both alpha-T and beta-C were significantly lower in the CAD group than those in control group (P < 0.05); in CAD group, mean values of alpha-T and beta-C were 11.9 +/- 7.2 (micrograms/ml), 35.8 +/- 3.1 (micrograms/dl) respectively. As for the levels of beta-C, it shows inverse relation with age, but not for the alpha-T levels. Serum levels of both vitamins did not show any significant differences in terms of sex, but men have a tendency o higher levels of beta-C, but lower levels of alpha-T.

Topics: Adult; beta Carotene; Carotenoids; Case-Control Studies; Coronary Disease; Cryptoxanthins; Female; Humans; Korea; Lycopene; Male; Vitamin A; Vitamin E; Xanthophylls; Zeaxanthins

The prevalence of coronary artery disease (CAD) in the urban population of India is similar to that in developed countries; Indian immigrants in industrialized countries have the highest prevalence of CAD. This is a cross-sectional survey within a random sample of a single urban setting in India. The relation between risk of CAD and plasma levels of vitamins A, C, E, and beta-carotene was examined in 72 of 595 elderly subjects (12.1%) with CAD (aged 50 to 84 years). Plasma levels of vitamins A, C, E, and beta-carotene were significantly related to risk of CAD. Smoking (n = 145) and diabetes (n = 70) were the confounding factors. Lipid peroxides were higher in patients with CAD and diabetes, and in those who smoked. The inverse relation between CAD and low plasma vitamin C was substantially reduced after adjustment for smoking and diabetes. Vitamin A and E levels remained independently and inversely related to the risk of CAD after adjustment for age, smoking, diabetes, blood pressure, blood lipoproteins, and relative weight and body mass index. The adjusted odds ratios for CAD between the lowest and highest quintiles of vitamin E levels were 2.53 (95% confidence interval [CI] 1.11 to 5.31), vitamin C, 2.21 (95% CI 1.12 to 3.15), and beta-carotene, 1.72 (95% CI 0.88 to 3.62). The fatty acid composition of the diet, blood lipid levels, central obesity (waist-hip ratio), smoking habits, blood pressure, and plasma insulin levels do not appear to account for high rates of CAD among elderly Indians.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Aged; Aged, 80 and over; Antioxidants; Ascorbic Acid; beta Carotene; Carotenoids; Coronary Disease; Cross-Sectional Studies; Diet; Female; Humans; India; Male; Middle Aged; Oxidative Stress; Risk Factors; Smoking; Vitamin E

Topics: Aged; Anticholesteremic Agents; Aspirin; beta Carotene; Carotenoids; Cholesterol, Dietary; Coronary Disease; Diet, Fat-Restricted; Diltiazem; Drug Therapy, Combination; Enalapril; Humans; Lovastatin; Male; Simvastatin; Tomography, Emission-Computed; Vitamins

Because antioxidants may play a role in the prevention of coronary heart disease by inhibiting the peroxidation of polyunsaturated fatty acids (PUFAs), the combined association of diet-derived antioxidants and PUFAs with acute myocardial infarction (MI) was investigated. This multicenter case-control study included 674 patients and 725 control subjects in eight European countries and Israel. Fatty acid composition and alpha-tocopherol and beta-carotene levels were determined in adipose tissue; selenium level was determined in toenails. For alpha-tocopherol no association with MI was observed at any PUFA level. The overall multivariate odds ratio (OR) for low (10th percentile) versus high (90th percentile) beta-carotene was 1.98 (95% confidence interval [CI], 1.39 to 2.82). The strength of this inverse association with MI was dependent on PUFA levels (in tertiles): for low PUFA, the OR for low versus high beta-carotene was 1.79 (95% CI, 0.98 to 3.25), for medium PUFA the OR was 1.76 (95% CI, 1.00 to 3.11), and for high PUFA 3.47 (95% CI, 1.93 to 6.24). For selenium increased risk was observed only at the lowest PUFA tertile (OR, 2.49; 95% CI, 1.22 to 5.09). This interaction between selenium and PUFAs was not significant and may at least partly be explained by a higher proportion of smokers at the low PUFA level. These findings support the hypothesis that beta-carotene plays a role in the protection of PUFAs against oxidation and subsequently in the protection against MI. No evidence was found that alpha-tocopherol or selenium may protect against MI at any level of PUFA intake.

Topics: Adipose Tissue; Antioxidants; beta Carotene; Carotenoids; Case-Control Studies; Coronary Disease; Fatty Acids, Unsaturated; Humans; Male; Middle Aged; Multivariate Analysis; Myocardial Infarction; Nails; Risk Factors; Selenium; Smoking; Toes

Oxidative modifications of blood serum in humans with and without coronary artery disease were investigated. Four parameters were analyzed: the intensity of serum fluorescence, which is indicative of the content of lipofuscine-like lipid peroxidation products; the content of thiobarbituric acid-reactive substances; the lag-phase of serum oxidation by azo-compounds; and the content of lipophilic natural antioxidants--alpha-tocopherol, beta-carotene and ubiquinol-9(10). It was found that coronary artery disease resulted in a significant increase of serum fluorescence and the content of TBARS. The atherogenic disorders in humans with coronary artery disease drastically decreased the lag-phase of serum oxidation in the presence of 2,2'-azo-bis-(2-amidinopropane) dihydrochloride. The oxidative modifications of serum were in close correlation with the balance of natural lipophilic antioxidants in blood serum, i.e. alpha-tocopherol, ubiquinols and beta-carotene. The contents of all antioxidants tested in serum were significantly decreased in patients with coronary artery disease.

Topics: Aged; Amidines; Analysis of Variance; beta Carotene; Biomarkers; Coronary Disease; Female; Free Radicals; Humans; Lipid Peroxidation; Lipid Peroxides; Male; Middle Aged; Oxidation-Reduction; Thiobarbituric Acid Reactive Substances; Ubiquinone; Vitamin E

The prevalence of coronary artery (CAD) disease in the Indian urban population is comparable to British population. Dietary intakes, antioxidant vitamins, prevalence of risk factors and CAD, were studied in a random sample of 152 adult urban subjects between 26-65 years of age (80 males, 72 females) from Peerzada street, Moradabad and compared with Indian immigrants to U.K. and a British comparison group. There was no significant relation with vitamin A. Smoking and diabetes were the confounding factors. Plasma antioxidant vitamin C (21.6 +/- 3.3 vs 42.5 +/- 4.5 mumol/L), vitamin E (15.2 +/- 2.8 vs 21.4 +/- 3.2 mumol/L) and beta-carotene (0.33 +/- 0.6 vs 0.55 +/- 0.08 mumol/L) were significantly lowered and lipid peroxides higher (2.82 +/- 0.22 vs 1.3 +/- 0.20 nmol/ml) in patients with CAD compared to subjects without any risk factors. The relation between low plasma level of vitamin C and E levels and carotene remained independently and inversely related after adjustment for smoking, diabetes and other risk factors. Regression analysis showed that after adjustment. Odd's ratio for carotene (1.82, 95% C.I. 0.50 to 3.72), vitamin C (2.23, 95% C.I. 1.14 to 5.26) and vitamin E (2.35, 95% C.I. 1.29 to 5.30) were significantly related to CAD. Underlying these changes, dietary intake of vitamin A, E, C and beta-carotene was significantly less in patients with CAD. Vitamin C and beta-carotene intake were less in smokers and diabetes. Compared with British population, the Indian urbans consumed less total and saturated fat and cholesterol and more polyunsaturated fat and complex carbohydrates. The plasma total and low density lipoprotein cholesterol levels were less in Indian urbans compared to Britons and so were mean body weight, body mass index and waist-hip ratio. Plasma insulin levels were comparable. The fatty acid composition of the diet, blood lipids, central obesity and insulin levels do not appear to account for high rates of CAD among Indians. The findings suggest that urban population in India may benefit from eating diets rich in antioxidant vitamin C, E and beta-carotene.

Topics: Adult; Aged; Antioxidants; Ascorbic Acid; beta Carotene; Carotenoids; Coronary Disease; Diet; Dietary Fats; Emigration and Immigration; Female; Humans; India; Male; Middle Aged; Oxidative Stress; Prospective Studies; Risk Factors; United Kingdom; Urban Health; Vitamin A; Vitamin E; Vitamins

Plasma concentrations of the antioxidants, vitamin E, beta-carotene and vitamin A were studied. 29 patients in whom at least 70% obstruction of 1 coronary artery was found, and 73 who were normal according to noninvasive tests were compared using multivariable, logistic, regression analysis. The group with coronary disease had significantly lower plasma vitamin E and beta-carotene concentrations as compared with the normal group (means +/- SD: 44.2 +/- 18.3 micrograms/ml vs 50.6 +/- 22.4 and 1.0 +/- 0.5 micrograms/ml vs 1.1, respectively) but plasma vitamin A concentration was not reduced. Decrease in plasma antioxidant vitamin concentrations may be linked to atherogenesis by LDL oxidative modification, which explains the inverse relationship found between the risk of coronary artery disease and plasma antioxidant vitamins.

Topics: Antioxidants; beta Carotene; Carotenoids; Coronary Disease; Humans; Vitamin A; Vitamin E

The natural antioxidant beta-carotene which, unlike phenol antioxidants such as dibunol and SPN-6, is capable of exhibiting antioxidative properties under low partial oxygen pressure (ischemia), has been found to increase the activity of antioxidative enzymes in the intact and infarct myocardium and to greatly exert a more antinecrotic action when given orally in a dose of 20 mg/kg in models of rat coronary-occlusion myocardial infarction than the phenol antioxidants mentioned above. Intravenous administration of copper-containing enzymes utilizing O2 superoxide dismutase (SOD), 4 mg/kg, or ceruloplasmin, 50 mg/kg, as with a highly disperse copper powder promoting a substantial increase in antioxidative enzyme activity in the rat myocardium has been demonstrated to reduce the zone of myocardial ischemic lesion in rats and to largely enhance postoperative survival rates in the animals. Three hours following intravenous SOD, an electron microscopic examination of rat ischemic myocardium showed a considerable fall in the structural and functional damages to cardiomyocytes in the periischemic area. The findings suggest that free radical processes make a contribution to ischemic cardiomyocyte lesion and open the way for pharmacological therapy of postischemic abnormalities with enzymatic and non-enzymatic preparations of antioxidants.

Topics: Animals; Antioxidants; beta Carotene; Carotenoids; Coronary Disease; Free Radicals; Glutathione Peroxidase; Glutathione Transferase; Heart; Lipid Peroxidation; Liver; Male; Myocardium; Rats; Rats, Inbred Strains; Superoxide Dismutase; Superoxides

Topics: Adult; Antioxidants; Ascorbic Acid; beta Carotene; Carotenoids; Coronary Disease; Cross-Cultural Comparison; Cross-Sectional Studies; Humans; Male; Middle Aged; Neoplasms; Prospective Studies; Vitamin A; Vitamin E; Vitamins