Skip to main content
SpringerLink
Log in

Dietary non enzymatic antioxidant capacity and the risk of myocardial infarction in the Swedish women’s lifestyle and health cohort

  • CARDIOVASCULAR DISEASE
  • Published:
European Journal of Epidemiology Aims and scope Submit manuscript

Abstract

Foods rich in antioxidants have been associated with a reduced risk of myocardial infarction. However, findings from randomized clinical trials on the role of antioxidant supplementation remain controversial. It has been suggested that antioxidants interact with each other to promote cardiovascular health. We therefore investigated the association between dietary Non Enzymatic Antioxidant Capacity (NEAC), measuring the total antioxidant potential of the whole diet, and the risk of myocardial infarction. We followed 45,882 women aged 30–49 years and free from cardiovascular diseases through record linkages from 1991 until 2012. Dietary NEAC was assessed by a validated food frequency questionnaire collected at baseline. Total dietary NEAC was categorized into quintiles and multivariable Cox proportional hazard regression models were fitted to estimate hazard ratios (HR) with 95% confidence intervals (CI). During a mean follow-up time of 20.3 years we detected 657 incident cases of myocardial infarction. After adjusting for potential confounders, we found a significant 28% lower risk of myocardial infarction among women in the fourth (HR: 0.72; 95% CI 0.55–0.95) and a 40% lower risk among women in the fifth quintile (HR: 0.60, 95% CI 0.45–0.81) of dietary NEAC compared to women in the first quintile, with a significant trend (p-value < 0.001). Higher dietary NEAC is associated with a lower risk of myocardial infarction in young to middle-aged women. These findings support the hypothesis that dietary antioxidants protect from myocardial infarction and that this effect might be exerted through interactions between antioxidants.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Roth GA, Huffman MD, Moran AE, et al. Global and Regional Patterns in Cardiovascular Mortality From 1990 to 2013. Circulation. 2015;132(17):1667–78. https://doi.org/10.1161/Circulationaha.114.008720.

    Article  PubMed  Google Scholar 

  2. Kaliora AC, Dedoussis GV, Schmidt H. Dietary antioxidants in preventing atherogenesis. Atherosclerosis. 2006;187(1):1–17. https://doi.org/10.1016/j.atherosclerosis.2005.11.001.

    Article  CAS  PubMed  Google Scholar 

  3. Salvayre R, Negre-Salvayre A, Camare C. Oxidative theory of atherosclerosis and antioxidants. Biochimie. 2015. https://doi.org/10.1016/j.biochi.2015.12.014.

    PubMed  Google Scholar 

  4. Wang S, Melnyk JP, Tsao R, Marcone MF. How natural dietary antioxidants in fruits, vegetables and legumes promote vascular health. Food Res Int. 2011;44(1):14–22.

    Article  CAS  Google Scholar 

  5. Dauchet L, Amouyel P, Hercberg S, Dallongeville J. Fruit and vegetable consumption and risk of coronary heart disease: a meta-analysis of cohort studies. J Nutr. 2006;136(10):2588–93.

    Article  CAS  PubMed  Google Scholar 

  6. Gaziano JM, Manson JE, Branch LG, Colditz GA, Willett WC, Buring JE. A prospective study of consumption of carotenoids in fruits and vegetables and decreased cardiovascular mortality in the elderly. Ann Epidemiol. 1995;5(4):255–60.

    Article  CAS  PubMed  Google Scholar 

  7. Tavani A, Negri E, D’Avanzo B, La Vecchia C. Beta-carotene intake and risk of nonfatal acute myocardial infarction in women. Eur J Epidemiol. 1997;13(6):631–7.

    Article  CAS  PubMed  Google Scholar 

  8. Klipstein-Grobusch K, Geleijnse JM, den Breeijen JH, et al. Dietary antioxidants and risk of myocardial infarction in the elderly: the Rotterdam Study. The American Journal of Clinical Nutrition. 1999;69(2):261–6.

    Article  CAS  PubMed  Google Scholar 

  9. Willcox BJ, Curb JD, Rodriguez BL. Antioxidants in cardiovascular health and disease: key lessons from epidemiologic studies. Am J Cardiol. 2008;101(10A):75D–86D. https://doi.org/10.1016/j.amjcard.2008.02.012.

    Article  CAS  PubMed  Google Scholar 

  10. Cassidy A, Mukamal KJ, Liu L, Franz M, Eliassen AH, Rimm EB. High Anthocyanin Intake Is Associated With a Reduced Risk of Myocardial Infarction in Young and Middle-Aged Women. Circulation. 2013;127(2):188–96. https://doi.org/10.1161/Circulationaha.112.122408.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Virtamo J, Rapola JM, Ripatti S, et al. Effect of vitamin E and beta carotene on the incidence of primary nonfatal myocardial infarction and fatal coronary heart disease. Arch Intern Med. 1998;158(6):668–75.

    Article  CAS  PubMed  Google Scholar 

  12. Cook NR, Albert CM, Gaziano JM, et al. A Randomized factorial trial of vitamins C and E and beta carotene in the secondary prevention of cardiovascular events in women - Results from the women’s antioxidant cardiovascular study. Arch Intern Med. 2007;167(15):1610–8. https://doi.org/10.1001/archinte.167.15.1610.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Lee IM, Cook NR, Gaziano JM, et al. Vitamin E in the primary prevention of cardiovascular disease and cancer: the Women’s Health Study: a randomized controlled trial. JAMA. 2005;294(1):56–65. https://doi.org/10.1001/jama.294.1.56.

    Article  CAS  PubMed  Google Scholar 

  14. Lonn E, Bosch J, Yusuf S, et al. Effects of long-term vitamin E supplementation on cardiovascular events and cancer: a randomized controlled trial. JAMA. 2005;293(11):1338–47. https://doi.org/10.1001/jama.293.11.1338.

    Article  PubMed  Google Scholar 

  15. Serafini M, Del Rio D. Understanding the association between dietary antioxidants, redox status and disease: is the Total Antioxidant Capacity the right tool? Redox Rep. 2004;9(3):145–52. https://doi.org/10.1179/135100004225004814.

    Article  CAS  PubMed  Google Scholar 

  16. Liu RH. Health benefits of fruit and vegetables are from additive and synergistic combinations of phytochemicals. The American journal of clinical nutrition. 2003;78(3 Suppl):517S–20S.

    Article  CAS  PubMed  Google Scholar 

  17. Rautiainen S, Levitan EB, Orsini N, et al. Total antioxidant capacity from diet and risk of myocardial infarction: a prospective cohort of women. Am J Med. 2012;125(10):974–80. https://doi.org/10.1016/j.amjmed.2012.03.008.

    Article  CAS  PubMed  Google Scholar 

  18. Rossi M, Praud D, Monzio Compagnoni M, et al. Dietary non-enzymatic antioxidant capacity and the risk of myocardial infarction: a case-control study in Italy. Nutrition, metabolism, and cardiovascular diseases: NMCD. 2014;24(11):1246–51. https://doi.org/10.1016/j.numecd.2014.06.007.

    Article  CAS  PubMed  Google Scholar 

  19. Roswall N, Sandin S, Adami HO, Weiderpass E. Cohort Profile: the Swedish Women’s Lifestyle and Health cohort. Int J Epidemiol. 2015. https://doi.org/10.1093/ije/dyv089.

    Google Scholar 

  20. Michels KB, Willett WC. Self-administered semiquantitative food frequency questionnaires: patterns, predictors, and interpretation of omitted items. Epidemiology. 2009;20(2):295–301. https://doi.org/10.1097/EDE.0b013e3181931515.

    Article  PubMed  PubMed Central  Google Scholar 

  21. National Food Administration. Food composition tables. Uppsala, Sweden: National Food Administration; 1989

    Google Scholar 

  22. Carlsen MH, Halvorsen BL, Holte K, et al. The total antioxidant content of more than 3100 foods, beverages, spices, herbs and supplements used worldwide. Nutr J. 2010;9. https://doi.org/10.1186/1475-2891-9-3.

  23. Rautiainen S, Serafini M, Morgenstern R, Prior RL, Wolk A. The validity and reproducibility of food-frequency questionnaire-based total antioxidant capacity estimates in Swedish women. The American journal of clinical nutrition. 2008;87(5):1247–53.

    Article  CAS  PubMed  Google Scholar 

  24. Pellegrini N, Salvatore S, Valtuena S, et al. Development and validation of a food frequency questionnaire for the assessment of dietary total antioxidant capacity. (vol 137, pg 93, 2007). Journal of Nutrition. 2007;137(6):1499-.

  25. Puchau B, Zulet MA, de Echavarri AG, Hermsdorff HHM, Martinez JA. Dietary total antioxidant capacity is negatively associated with some metabolic syndrome features in healthy young adults. Nutrition. 2010;26(5):534–41. https://doi.org/10.1016/J.Nut.2009.06.017.

    Article  CAS  PubMed  Google Scholar 

  26. Serafini M, Jakszyn P, Lujan-Barroso L, et al. Dietary total antioxidant capacity and gastric cancer risk in the European prospective investigation into cancer and nutrition study. Int J Cancer. 2012;131(4):E544–54. https://doi.org/10.1002/ijc.27347.

    Article  CAS  PubMed  Google Scholar 

  27. Delgado-Andrade C, Morales FJ. Unraveling the contribution of melanoidins to the antioxidant activity of coffee brews. J Agric Food Chem. 2005;53(5):1403–7. https://doi.org/10.1021/jf048500p.

    Article  CAS  PubMed  Google Scholar 

  28. Morales FJ, Somoza V, Fogliano V. Physiological relevance of dietary melanoidins. Amino Acids. 2012;42(4):1097–109. https://doi.org/10.1007/S00726-010-0774-1.

    Article  CAS  PubMed  Google Scholar 

  29. Willett WC, Howe GR, Kushi LH. Adjustment for total energy intake in epidemiologic studies. The American journal of clinical nutrition. 1997;65(4 Suppl):1220S-8S; discussion 9S-31S.

  30. Breslow N. Covariance analysis of censored survival data. Biometrics. 1974;30(1):89–99.

    Article  CAS  PubMed  Google Scholar 

  31. Harrell F. Regression modeling strategies: with applications to linear models, logistic and ordinal regression, and survival analysis: Springer; 2015.

  32. Knol MJ, VanderWeele TJ, Groenwold RH, Klungel OH, Rovers MM, Grobbee DE. Estimating measures of interaction on an additive scale for preventive exposures. Eur J Epidemiol. 2011;26(6):433–8. https://doi.org/10.1007/s10654-011-9554-9.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Pellegrini N, Serafini M, Colombi B, et al. Total antioxidant capacity of plant foods, beverages and oils consumed in Italy assessed by three different in vitro assays. The Journal of nutrition. 2003;133(9):2812–9.

    Article  CAS  PubMed  Google Scholar 

  34. Pellegrini N, Serafini M, Salvatore S, Del Rio D, Bianchi M, Brighenti F. Total antioxidant capacity of spices, dried fruits, nuts, pulses, cereals and sweets consumed in Italy assessed by three different in vitro assays. Mol Nutr Food Res. 2006;50(11):1030–8. https://doi.org/10.1002/mnfr.200600067.

    Article  CAS  PubMed  Google Scholar 

  35. Horton NJ, Kleinman KP. Much ado about nothing: a comparison of missing data methods and software to fit incomplete data regression models. The American statistician. 2007;61(1):79–90. https://doi.org/10.1198/000313007X172556.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Ye Y, Li J, Yuan Z. Effect of antioxidant vitamin supplementation on cardiovascular outcomes: a meta-analysis of randomized controlled trials. PLoS ONE. 2013;8(2):e56803. https://doi.org/10.1371/journal.pone.0056803.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Myung S-K, Ju W, Cho B, et al. Efficacy of vitamin and antioxidant supplements in prevention of cardiovascular disease: systematic review and meta-analysis of randomised controlled trials. BMJ. 2013;346. https://doi.org/10.1136/bmj.f10.

  38. Vivekananthan DP, Penn MS, Sapp SK, Hsu A, Topol EJ. Use of antioxidant vitamins for the prevention of cardiovascular disease: meta-analysis of randomised trials. Lancet. 2003;361(9374):2017–23. https://doi.org/10.1016/S0140-6736(03)13637-9.

    Article  CAS  PubMed  Google Scholar 

  39. Miller ER, Pastor-Barriuso R, Dalal D, Riemersma RA, Appel LJ, Guallar E. Meta-analysis: high-dosage vitamin E supplementation may increase all-cause mortality. Ann Intern Med. 2005;142(1):37–46.

    Article  CAS  PubMed  Google Scholar 

  40. Carocho M, Ferreira IC. A review on antioxidants, prooxidants and related controversy: natural and synthetic compounds, screening and analysis methodologies and future perspectives. Food Chem Toxicol. 2013;51:15–25. https://doi.org/10.1016/j.fct.2012.09.021.

    Article  CAS  PubMed  Google Scholar 

  41. Geleijnse JM, Launer LJ, van der Kuip DAM, Hofman A, Witteman JCM. Inverse association of tea and flavonoid intakes with incident myocardial infarction: the Rotterdam Study. Am J Clin Nutr. 2002;75(5):880–6.

    Article  CAS  PubMed  Google Scholar 

  42. Hooper L, Kroon PA, Rimm EB, et al. Flavonoids, flavonoid-rich foods, and cardiovascular risk: a meta-analysis of randomized controlled trials. The American journal of clinical nutrition. 2008;88(1):38–50.

    Article  CAS  PubMed  Google Scholar 

  43. John JH, Ziebland S, Yudkin P, et al. Effects of fruit and vegetable consumption on plasma antioxidant concentrations and blood pressure: a randomised controlled trial. Lancet. 2002;359(9322):1969–74.

    Article  CAS  PubMed  Google Scholar 

  44. Aune D, Giovannucci E, Boffetta P, et al. Fruit and vegetable intake and the risk of cardiovascular disease, total cancer and all-cause mortality-a systematic review and dose-response meta-analysis of prospective studies. Int J Epidemiol. 2017. https://doi.org/10.1093/ije/dyw319.

    PubMed Central  Google Scholar 

  45. Franzini L, Ardigo D, Valtuena S, et al. Food selection based on high total antioxidant capacity improves endothelial function in a low cardiovascular risk population. Nutrition, metabolism, and cardiovascular diseases: NMCD. 2012;22(1):50–7. https://doi.org/10.1016/j.numecd.2010.04.001.

    Article  CAS  PubMed  Google Scholar 

  46. Wang Y, Yang M, Lee SG, et al. Diets high in total antioxidant capacity improve risk biomarkers of cardiovascular disease: a 9-month observational study among overweight/obese postmenopausal women. Eur J Nutr. 2014;53(6):1363–9. https://doi.org/10.1007/s00394-013-0637-0.

    Article  CAS  PubMed  Google Scholar 

  47. Kim K, Vance TM, Chun OK. Greater Total Antioxidant Capacity from Diet and Supplements Is Associated with a Less Atherogenic Blood Profile in U.S. Adults. Nutrients. 2016;8(1). https://doi.org/10.3390/nu8010015.

  48. Rothman KJ, Greenland S, Lash TL. Modern epidemiology: Lippincott Williams & Wilkins; 2008.

  49. Peters HW, Westendorp ICD, Hak AE, et al. Menopausal status and risk factors for cardiovascular disease. J Intern Med. 1999;246(6):521–8. https://doi.org/10.1046/j.1365-2796.1999.00547.x.

    Article  CAS  PubMed  Google Scholar 

  50. National Board of Health and Welfare. Värdering av diagnoskvaliten för akut hjärtinfarkt i patientregistret 1987 och 1995 (Evaluation of the validity of the diagnosis of acute myocardial infarction in the Patient Registry 1987 and 1995): Stockholm: National Board of Health and Welfare, Center of Epidemiology2000.

Download references

Acknowledgements

This study was sponsored by Grant K2012-69X-22062-01-3 from the Swedish Research Council and by the Swedish Cancer Society.

Author information

Authors and Affiliations

  1. Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Edificio U7, Via Bicocca degli Arcimboldi 8, 20126, Milan, Italy

    Essi Hantikainen & Rino Bellocco

  2. Department of Biosciences and Nutrition, Karolinska Institutet, NOVUM, 141 83, Huddinge, Sweden

    Marie Löf

  3. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, P.O. Box 281, 171 77, Stockholm, Sweden

    Alessandra Grotta, Rino Bellocco & Elisabete Weiderpass

  4. Centre for Health Equity Studies, Stockholm University/Karolinska Institutet, 106 91, Stockholm, Sweden

    Alessandra Grotta

  5. Department of Medicine, Clinical Epidemiology Unit T2, Karolinska University Hospital, 171 76, Stockholm, Sweden

    Ylva Trolle Lagerros

  6. Department of Medicine, Clinic of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital Huddinge, C2:84, 141 86, Stockholm, Sweden

    Ylva Trolle Lagerros

  7. Functional Food and Metabolic Stress Prevention Laboratory, Faculty of BioSciences and Technology for Food, Agriculture and Environment, University of Teramo, via R. Balzarini 1, 64100, Teramo, Italy

    Mauro Serafini

  8. Department of Research, Cancer Registry of Norway, Institute of Population-Based Cancer Research, P.O. Box 5313, Majorstuen, 0304, Oslo, Norway

    Elisabete Weiderpass

  9. Department of Community Medicine, University of Tromsø, The Arctic University of Norway, P.O. Box 6020, Langnes, 9037, Tromsø, Norway

    Elisabete Weiderpass

  10. Genetic Epidemiology Group, Folkhälsan Research Center, 00250, Helsinki, Finland

    Elisabete Weiderpass

Authors
  1. Essi Hantikainen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marie Löf
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Alessandra Grotta
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ylva Trolle Lagerros
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Mauro Serafini
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Rino Bellocco
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Elisabete Weiderpass
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Elisabete Weiderpass.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hantikainen, E., Löf, M., Grotta, A. et al. Dietary non enzymatic antioxidant capacity and the risk of myocardial infarction in the Swedish women’s lifestyle and health cohort. Eur J Epidemiol 33, 213–221 (2018). https://doi.org/10.1007/s10654-018-0361-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10654-018-0361-4

Keywords

Search

Navigation