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Antioxidant vitamins and prevention of cardiovascular disease: Epidemiological and clinical trial data

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Lipids

Abstract

Naturally occurring antioxidants such as vitamin E, β-carotene, and vitamin C can inhibit the oxidative modification of low density lipoproteins. This action could positively influence the atherosclerotic process and, as a consequence, the progression of coronary heart disease. A wealth of experimental studies provide a sound biological rationale for the mechanisms of action of antioxidants, whereas epidemiologic studies strongly sustain the “antioxidant hypothesis”. To date, however, clinical trials with β-carotene supplements have been disappointing, and their use as a preventive intervention for cancer and coronary heart disease should be discouraged. Only scanty data from clinical trials are available for vitamin C. As to vitamin E, discrepant results have been obtained by the Alpha-Tocopherol, Beta Carotene Cancer Prevention Study with a low-dose vitamin E supplementation (50 mg/d) and the Cambridge Heart Antioxidant Study (400–800 mg/d). The results of the GISSI-Prevenzione (300 mg/d) and HOPE (400 mg/d) trials suggest the absence of relevant clinical effects of vitamin E on the risk of cardiovascular events. Currently ongoing are several large-scale clinical trials that will help in clarifying the role of vitamin E in association with other antioxidants in the prevention of atherosclerotic coronary disease.

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Abbreviations

ATBC trial:

Alpha-Tocopherol, Beta Carotene trial

GARET:

β-Carotene and Retinol Efficacy cancer prevention Trial

CHAOS:

Cambridge Heart Antioxidant Study

CHD:

coronary heart disease

CI:

confidence interval

CVD:

cardiovascular disease

GISSI:

Gruppo Italiano per lo Studio della Sopravyivenza nell'Infarto Miocardio

HOPE:

Heart Outcomes Prevention Evaluation

IHD:

ischemic heart disease

LDL:

low density lipoprotein

MI:

myocardial infarction

OR:

odds ratio

PHS:

Physicians' Health Study

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Authors and Affiliations

  1. Ospedale di Passirana di Rho, Milano, Italy

    Carlo Schweiger

  2. Ospedale di Vasto, Chieti, Italy

    Giacomo Levantesi

  3. Policlinico San Matteo, Pavia, Italy

    Luigi Tavazzi

  4. Ospedale di Monza, Italy

    Franco Valagussa

  5. Laboratory of Clinical Epidemiology of Cardiovascular Disease, Istituto di Ricerche Farmacologiche Mario Negri, Consorzio Mario Negri Sud, Via Nazionale, 66030, Santa Maria Imbaro (Chieti), Italy

    Roberto Marchioli

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  1. Roberto Marchioli
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  2. Carlo Schweiger
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  5. Franco Valagussa
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Correspondence to Roberto Marchioli.

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Marchioli, R., Schweiger, C., Levantesi, G. et al. Antioxidant vitamins and prevention of cardiovascular disease: Epidemiological and clinical trial data. Lipids 36 (Suppl 1), S53–S63 (2001). https://doi.org/10.1007/s11745-001-0683-y

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