Carotenoids are a class of natural fat-soluble pigments found principally in plants. They have potential antioxidant biological properties due to their chemical structure and interaction with biological membranes. The most abundant carotenoids in the diet are β-carotene, lycopene, lutein, β-cryptoxanthin, zeaxanthin, and astaxanthin. Numerous epidemiologic studies have supported the hypothesis that antioxidants could be used as an inexpensive means of prevention, and possibly treatment, of cardiovascular diseases, even though findings from interventional trials have been mixed, with some positive findings, many null findings, and some suggestion of harm in certain high-risk populations. Recent smaller interventional studies with carefully chosen populations, such as those under high levels of oxidative stress, have yielded largely positive results. This suggests that we need more hypothesisdriven and rigorous clinical trial designs. The aim of this review is to examine the published studies about the use of carotenoids, especially lycopene and astaxanthin, in the treatment of cardiovascular diseases.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
References and Recommended Reading
Vasan RS, Benjamin EJ, Sullivan LM, et al.: The burden of increasing worldwide cardiovascular disease. In Hurst’s, The Heart, edn 11. Edited by Fuster C, Wayne AR, O’Rourke RA. New York: McGraw-Hill; 2004:18–24.
Neaton J, Wentworth D: Serum cholesterol, blood pressure, cigarette smoking, and death from coronary heart disease. Overall findings and difference by age for 316.099 white men. Multiple Risk Factor Intervention Trial Research Group. Arch Intern Med 1992, 152:56–64.
Rao AV, Rao GL: Carotenoid and human health. Pharmacol Res 2007, 55:207–216.
Dzau J: Theodore Cooper lecture: Tissue angiotensin and pathobiology of vascular disease: a unifying hypothesis. Hypertension 2001, 37:1047–1052.
Halliwell B: Free radicals, antioxidants and human disease: curiosity, cause or consequence? Lancet 1994, 344:721–724.
Heller FR, Descamps O, Hondekijn JC: LDL oxidation: therapeutic perspectives. Atherosclerosis 1998, 137(Suppl):S25–S31.
Rosenfeld ME: Leukocyte recruitment into developing atherosclerotic lesion: the complex interaction between multiple molecules keeps getting more complex. Arterioscler Thromb Vasc Biol 2002, 22:361–363.
Khansari N, Shakiba Y, Mahmoudi M: Chronic inflammation and oxidative stress as a major cause of age-related diseases and cancer. Recent Pat Inflamm Allergy Drug Discov 2009, 3:73–80.
Dietary guidelines for Americans, edn 5. Home and Garden Bulletin no 232. Washington, DC: US Department of Agriculture, US Department of Health and Human Services; 2000.
Sies H, Stahl W: Vitamins E and C, beta-carotene, and other carotenoids as antioxidants. Am J Clin Nutr 1995, 62:1315S–1321S.
Gaziano JM, Manson JE, Branch LG, et al.: A prospective study of consumption of carotenoids in fruits and vegetables and decreased cardiovascular mortality in the elderly. Ann Epidemiol 1995, 5:255–260.
Jackson H, Braun CL, Ernst H: The chemistry of novel xanthophyll carotenoids. Am J Cardiol 2008, 101:50–57.
Britton G: Structure and properties of carotenoids in relation to function. FASEB J 1995, 9:1551–1558.
Clinton SK: Lycopene: chemistry, biology, and implications for human health and disease. Nutr Rev 1998, 56:35–51.
Miller NJ, Sampson J, Candeias LP, et al.: Antioxidant activities of carotenes and xanthophylls. FEBS Lett 1996, 384:240–246.
Stahl W, Schwarz W, Sundquist AR, et al.: Cis-trans isomers of lycopene and beta-carotene in human serum and tissues. Arch Biochem Biophys 1992, 294:173–177.
Michaud DS, Giovannucci EL, Ascherio A, et al.: Associations of plasma carotenoid concentrations and dietary intake of specific carotenoids in samples of two prospective cohort studies using a new carotenoid database. Cancer Epidemiol Biomarkers Prev 1998, 7:283–290.
Nguyen ML, Schwartz SJ: Lycopene: chemical and biological properties. Food Technol 1999, 53:38–45.
Zhang LX, Cooney RV, Bertram JS: Carotenoids up-regulate connexin43 gene expression independent of their provitamin A or antioxidant properties. Cancer Res 1992, 52:5707–5712.
Witztum JL: The oxidation hypothesis of atherosclerosis. Lancet 1994, 344:793–795.
Witztum JL: Role of oxidized low density lipoprotein in atherogenesis. Br Heart J 1993, 69:S12–S18.
Fuhramn B, Elis A, Aviram M: Hypocholesterolemic effect of lycopene and _-carotene is related to suppression of cholesterol synthesis and augmentation of LDL receptor activity in macrophage. Biochem Biophys Res Commun 1997, 233:658–662.
Agarwal S, Rao AV: Tomato lycopene and low density lipoprotein oxidation: a human dietary intervention study. Lipids 1998, 33:981–984.
Rao AV, Agarwal S: Effect of diet and smoking on serum lycopene and lipid peroxidation. Nutr Res 1998, 18:713–721.
Sesso HD, Buring JE, Norkus EP, et al.: Plasma lycopene, other carotenoids, retinol and the risk of cardiovascular disease in men. Am J Clin Nutr 2005, 81:990–997.
Hozawa A, Jacobs DR, Steffes MW, et al.: Relationships of circulating carotenoid concentrations with several markers of inflammation, oxidative stress, and endothelial dysfunction: the Coronary Artery Risk Development in Young Adults (CARDIA)/Young Adult Longitudinal Trends in Antioxidants (YALTA) study. Clin Chem 2007, 53:447–455.
Lidebjer C, Leanderson P, Ernerudh J, et al.: Low plasma levels of oxygenated carotenoids in patients with coronary artery disease. Nutr Metab Cardiovasc Dis 2007, 17:448–456.
Kohlmeier L, Kark JD, Gomez-Garcia E, et al.: Lycopene and miocardial infarction risk in the EURAMIC study. Am J Epidemiol 1997, 146:618–626.
Handelman GJ, Parker L, Cross CE: Destruction of tocopherols, carotenoids and retinol in human plasma by cigarette smoke. Am J Clin Nutr 1996, 63:559–565.
Kristenson M, Zieden B, Kucinskiene Z, et al.: Antioxidant state and mortality from coronary heart disease in Lithuanian and Swedish men: concomitant cross sectional study of men aged 50. BM J 1997, 314:629–633.
Ito Y, Kurata M, Suzuki K, Hamajima N, et al.: Cardiovascular disease mortality and serum carotenoid levels: a Japanese population-based follow-up study. J Epidemiol 2006, 16:154–160.
Irribarren C, Folson AR, Jacobs DR, et al.: Association of serum vitamin levels, LDL susceptibility to oxidation, and autoantibodies against MDA-LDL with carotid atherosclerosis. Arterioscler Thromb Vasc Biol 1997, 17:1171–1177.
Bose KS, Agrawal BK: Effect of lycopene from cooked tomatoes on serum antioxidant enzymes, lipid peroxidation rate and lipide profile in coronary heart disease. Singapore Med J 2007, 48:415–420.
Visioli F, Riso P, Grande S, Galli C, et al.: Protective activity of tomato products on in vivo markers of lipid oxidation. Eur J Nutr 2003, 42:201–206.
Fuhrman B, Elis A, Aviram M: Hypercholesterolemic effect of lycopene and beta-carotene is related to suppression of cholesterol synthesis and augmentation of LDL receptor activity in macrophage. Biochem Biophys Res Commun 1997, 233:658–662.
Rao AV, Agarwal S: Bioavailability and in vivo antioxidant properties of lycopene from tomato products and their possible role in the prevention of cancer. Nutr Cancer 1998, 31:199–203.
Agarwal S, Rao AV: Tomato lycopene and low density lipoprotein oxidation: a human dietary intervention study. Lipids 1988, 33:981–984.
Paterson E, Gordon MH, Niwat C, et al.: Supplementation with fruit and vegetable soups and beverages increas plasma carotenoid concentrations but does not alter marker of oxidative stress or cardiovascular risk factors. J Nutr 2006, 136:2849–2855.
Pashkow FJ, Watumull DG, Campbell CL: Astaxanthin: a novel potential treatment for oxidative stress and inflammation in cardiovascular disease. Am J Cardiol 200X, 101:58–68.
Ernst H: Recent advances in industrial carotenoid synthesis. Pure Appl Chem 2002, 74:2213–2226.
Lockwood SF, Gross GJ: Disodium disuccinate astaxanthin (Cardax): antioxidant and antiinflammatory cardioprotection. Cardiovasc Drug Rev 2005, 23:199–216.
Gross GJ, Lockwood SF: Cardioprotection and myocardial salvage by a disodium disuccinate astaxanthin derivative (Cardax). Life Sci 2004, 5:215–224.
Gross, GJ, Hazen SL, Lockwood SF: Seven day oral supplementation with Cardax (disodium disuccinate astaxanthin) provides significant cardioprotection and reduces oxidative stress in rats. Mol Cell Biochem 2006, 283:23–30.
Lauver DA, Lockwood SF, Lucchesi BR: Disodium disuccinate astaxanthin (Cardax) attenuates complement activation and reduces myocardial injury following ischemia/reperfusion. J Pharmacol Exp Ther 2005, 314:686–692.
Iwamoto T, Hosoda K, Hirano R; Inhibition of low-density lipoprotein oxidation by astaxanthin. J Atheroscler Thromb 2000, 7:216–222.
Rufer CE, Moeseneder J, Briviba K, et al.: Bioavailability of astaxanthin stereoisomers from wild (Oncorhynchus spp.) and aquacultured (Salmo salar) salmon in healthy men: a randomised, double-blind study. Br J Nutr 2008, 99:1048–1054.
Coral-Hinostroza GN, Ytrestoyl T, Ruyter T, et al.: Plasma appearance of unesterified astaxanthin geometrical E/Z and optical R/S isomers in men given single doses of a mixture of optical 3 and 3′R/S isomers of astaxanthin fatty acyl diesters. Comp Biochem Physiol C Toxicol Pharmacol 2004, 139:99–110.
Spiller GA, Dewell A: Safety of an astaxanthin-rich Haematococcus pluvialis algal extract: a randomized clinical trial. J Med Food 2003, 6:51–56.
Karppi J, Rissanen TH, Nyyssonen K: Effects of astaxanthin supplementation on lipid peroxidation. Int J Vitamin Nutr Res 2007, 77:3–11.
Fassett RG, Healy H, Driver R, et al.: Astaxanthin vs placebo on arterial stifness, oxidative stress and inflammation in renal transplant patients (xanthin): a randomised controlled trial. BMC Nephrol 2008, 18:9–17.
About this article
Cite this article
Riccioni, G. Carotenoids and cardiovascular disease. Curr Atheroscler Rep 11, 434–439 (2009). https://doi.org/10.1007/s11883-009-0065-z
- Arterioscler Thromb Vasc Biol