, Volume 36, Supplement 1, pp S53-S63

First online:

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

  • Roberto MarchioliAffiliated withLaboratory of Clinical Epidemiology of Cardiovascular Disease, Istituto di Ricerche Farmacologiche Mario Negri, Consorzio Mario Negri Sud Email author 
  • , Carlo SchweigerAffiliated withOspedale di Passirana di Rho
  • , Giacomo LevantesiAffiliated withOspedale di Vasto
  • , Luigi TavazziAffiliated withPoliclinico San Matteo
  • , Franco ValagussaAffiliated withOspedale di Monza

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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.