Vitamin E consumption and the risk of coronary disease in women.

BACKGROUND Interest in the antioxidant vitamin E as a possible protective nutrient against coronary disease has intensified with the recognition that oxidized low-density lipoprotein may be involved in atherogenesis. METHODS In 1980, 87,245 female nurses 34 to 59 years of age who were free of diagnosed cardiovascular disease and cancer completed dietary questionnaires that assessed their consumption of a wide range of nutrients, including vitamin E. During follow-up of up to eight years (679,485 person-years) that was 97 percent complete, we documented 552 cases of major coronary disease (437 nonfatal myocardial infarctions and 115 deaths due to coronary disease). RESULTS As compared with women in the lowest fifth of the cohort with respect to vitamin E intake, those in the top fifth had a relative risk of major coronary disease of 0.66 (95 percent confidence interval, 0.50 to 0.87) after adjustment for age and smoking. Further adjustment for a variety of other coronary risk factors and nutrients, including other antioxidants, had little effect on the results. Most of the variability in intake and reduction in risk was attributable to vitamin E consumed as supplements. Women who took vitamin E supplements for short periods had little apparent benefit, but those who took them for more than two years had a relative risk of major coronary disease of 0.59 (95 percent confidence interval, 0.38 to 0.91) after adjustment for age, smoking status, risk factors for coronary disease, and use of other antioxidant nutrients (including multi-vitamins). CONCLUSIONS Although these prospective data do not prove a cause-and-effect relation, they suggest that among middle-aged women the use of vitamin E supplements is associated with a reduced risk of coronary heart disease. Randomized trials of vitamin E in the primary and secondary prevention of coronary disease are being conducted; public policy recommendations about the widespread use of vitamin E should await the results of these trials.

[1]  E. Rimm,et al.  Vitamin E consumption and the risk of coronary heart disease in men. , 1993, The New England journal of medicine.

[2]  S. Grundy,et al.  Effect of dietary supplementation with alpha-tocopherol on the oxidative modification of low density lipoprotein. , 1992, Journal of lipid research.

[3]  A. Hamsten,et al.  Susceptibility to low-density lipoprotein oxidation and coronary atherosclerosis in man , 1992, The Lancet.

[4]  F. Kok,et al.  Supplementation with vitamin E but not beta-carotene in vivo protects low density lipoprotein from lipid peroxidation in vitro. Effect of cigarette smoking. , 1992, Arteriosclerosis and thrombosis : a journal of vascular biology.

[5]  J. Salonen,et al.  Autoantibody against oxidised LDL and progression of carotid atherosclerosis , 1992, The Lancet.

[6]  Verlangieri Aj,et al.  Effects of d-alpha-tocopherol supplementation on experimentally induced primate atherosclerosis. , 1992 .

[7]  L. Packer,et al.  Recycling of vitamin E in human low density lipoproteins. , 1992, Journal of lipid research.

[8]  S. King,et al.  Vitamin E supplementation, plasma lipids and incidence of restenosis after percutaneous transluminal coronary angioplasty (PTCA). , 1992, Journal of the American College of Nutrition.

[9]  J. Manson,et al.  Postmenopausal estrogen therapy and cardiovascular disease. Ten-year follow-up from the nurses' health study. , 1991, The New England journal of medicine.

[10]  D. Steinberg Antioxidants and atherosclerosis. A current assessment. , 1991, Circulation.

[11]  A. Szewczyk,et al.  Inhibition of cell proliferation by alpha-tocopherol. Role of protein kinase C. , 1991, The Journal of biological chemistry.

[12]  D. Wood,et al.  Risk of angina pectoris and plasma concentrations of vitamins A, C, and E and carotene , 1991, The Lancet.

[13]  W. Willett,et al.  Food predictors of plasma beta-carotene and alpha-tocopherol: validation of a food frequency questionnaire. , 1990, American journal of epidemiology.

[14]  S. Ylä-Herttuala,et al.  Distribution of oxidation specific lipid-protein adducts and apolipoprotein B in atherosclerotic lesions of varying severity from WHHL rabbits. , 1990, Arteriosclerosis.

[15]  K. Kugiyama,et al.  Impairment of endothelium-dependent arterial relaxation by lysolecithin in modified low-density lipoproteins , 1990, Nature.

[16]  G A Colditz,et al.  Food-based validation of a dietary questionnaire: the effects of week-to-week variation in food consumption. , 1989, International journal of epidemiology.

[17]  J L Witztum,et al.  Evidence for the presence of oxidatively modified low density lipoprotein in atherosclerotic lesions of rabbit and man. , 1989, The Journal of clinical investigation.

[18]  M. Stringer,et al.  Lipid peroxides and atherosclerosis. , 1989, BMJ.

[19]  J L Witztum,et al.  Low density lipoprotein undergoes oxidative modification in vivo. , 1989, Proceedings of the National Academy of Sciences of the United States of America.

[20]  J. Steinberg Book ReviewAmbulatory Pediatric Care , 1989 .

[21]  A. Bendich,et al.  Safety of oral intake of vitamin E. , 1988, The American journal of clinical nutrition.

[22]  W. Willett,et al.  Variability in portion sizes of commonly consumed foods among a population of women in the United States. , 1988, American journal of epidemiology.

[23]  R. Rauramaa,et al.  Relationship of serum selenium and antioxidants to plasma lipoproteins, platelet aggregability and prevalent ischaemic heart disease in Eastern Finnish men. , 1988, Atherosclerosis.

[24]  W. Willett,et al.  The relation of diet, cigarette smoking, and alcohol consumption to plasma beta-carotene and alpha-tocopherol levels. , 1988, American journal of epidemiology.

[25]  W. Willett,et al.  The use of a self-administered questionnaire to assess diet four years in the past. , 1988, American journal of epidemiology.

[26]  W. Willett,et al.  The influence of age, relative weight, smoking, and alcohol intake on the reproducibility of a dietary questionnaire. , 1987, International journal of epidemiology.

[27]  D. Steinberg,et al.  Oxidatively modified low density lipoproteins: a potential role in recruitment and retention of monocyte/macrophages during atherogenesis. , 1987, Proceedings of the National Academy of Sciences of the United States of America.

[28]  H. Stähelin,et al.  Plasma levels of antioxidant vitamins in relation to ischemic heart disease and cancer. , 1987, The American journal of clinical nutrition.

[29]  W. Willett,et al.  Dietary fat and the risk of breast cancer. , 1987, The New England journal of medicine.

[30]  Meir J. Stampfer,et al.  Total energy intake: implications for epidemiologic analyses. , 1986, American journal of epidemiology.

[31]  W. Willett,et al.  Validation of questionnaire information on risk factors and disease outcomes in a prospective cohort study of women. , 1986, American journal of epidemiology.

[32]  W. Willett,et al.  A prospective study of parental history of myocardial infarction and coronary heart disease in women. , 1986, American journal of epidemiology.

[33]  D. Steinberg,et al.  Endothelial cell-derived chemotactic activity for mouse peritoneal macrophages and the effects of modified forms of low density lipoprotein. , 1985, Proceedings of the National Academy of Sciences of the United States of America.

[34]  W. Willett,et al.  Reproducibility and validity of a semiquantitative food frequency questionnaire. , 1985, American journal of epidemiology.

[35]  D. Morel,et al.  Endothelial and Smooth Muscle Cells Alter Low Density Lipoprotein In Vitro by Free Radical Oxidation , 1984, Arteriosclerosis.

[36]  W. Willett,et al.  Test of the National Death Index. , 1984, American journal of epidemiology.

[37]  W. Willett,et al.  Validation of a dietary questionnaire with plasma carotenoid and alpha-tocopherol levels. , 1983, The American journal of clinical nutrition.

[38]  W. Willett,et al.  Vitamins A, E, and carotene: effects of supplementation on their plasma levels. , 1983, The American journal of clinical nutrition.

[39]  J. Warbasse,et al.  Quantitative evaluation of vitamin E in the treatment of angina pectoris. , 1977, American heart journal.

[40]  K. Haeger Long-time treatment of intermittent claudication with vitamin E , 1974 .

[41]  P. Livingstone,et al.  Treatment of intermittent claudication with vitamin E. , 1958, Lancet.