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Plasma antioxidants and coronary heart disease: vitamins C and E, and selenium
R A Riemersma1, M Oliver, R A Elton
1BHF Cardiovascular Research Unit, University of Edinburgh, Scotland.
Insights
This study investigated if plasma antioxidants like vitamins C and E, and selenium, are linked to coronary heart disease (CHD) mortality. Findings suggest these antioxidants do not explain regional differences in CHD rates across Europe.
Area of Science:
- Nutritional Epidemiology
- Cardiovascular Disease Research
Background:
- Coronary heart disease (CHD) exhibits significant regional variations in mortality.
- Plasma antioxidants, including vitamins C and E and selenium, are hypothesized to play a role in cardiovascular health.
Purpose of the Study:
- To examine the association between plasma concentrations of vitamins C and E, and selenium, and mortality from coronary heart disease (CHD).
- To investigate if regional differences in CHD mortality are explained by varying levels of these plasma antioxidants.
Main Methods:
- Cross-sectional population survey of apparently healthy middle-aged men in four European regions with differing CHD mortality rates.
- Measurement of plasma concentrations of vitamin C, vitamin E, selenium, and serum cholesterol.
- Analysis of regional differences in antioxidant levels and their correlation with CHD mortality rates.
Main Results:
- Plasma vitamin C levels were significantly lower in Scotland compared to other regions, but did not correlate with CHD mortality.
- Plasma vitamin E levels varied regionally, with lower levels in Scotland. Cholesterol-adjusted vitamin E levels were low in three high CHD areas, but not consistently lower in the highest mortality area.
- Serum selenium levels varied by region, with low levels confirmed in Finland, but showed no correlation with CHD mortality.
Conclusions:
- The study did not find evidence to support the hypothesis that plasma levels of vitamins C and E, or selenium, explain the observed regional differences in coronary heart disease mortality.
- Further research is needed to understand the complex multifactorial etiology of regional CHD mortality variations.
Abstract:
The possibility of a relation between plasma antioxidants such as vitamins C and E and selenium, and mortality from coronary heart disease (CHD) was examined. A cross-sectional survey was undertaken of random population samples of apparently healthy middle-aged men in four European regions with differing mortalities from CHD [rate/100,000 for men aged 40-49]: north Karelia (eastern Finland) (n = 99) [212/100,000]; south-west Finland (n = 85) [146/100,000]; Scotland (n = 131) [140/100,000]; and south Italy (n = 80) [43/100,000]. Median (5th-95th percentile) plasma vitamin C concentrations were lower in Scotland: 18.2 (5.7-61.3) microM than in other regions: north Karelia 28.4 (6.2-85.2); south-west Finland 33.5 (5.7-76.6); south Italy 38.0 (10.2-69.8) microM (P less than 0.001). The median levels in the four areas did not however reflect the regional CHD mortality rates. Regional differences in plasma vitamin E levels were also observed: Scottish levels were low 20.0 (12.1-29.3) microM (P less than 0.001) and did not differ between the other areas: 23.0 (16.7-35.1), 22.5 (13.7-31.6) and 23.9 (15.6-41.3) microM respectively. The vitamin E gradient could be explained in part by differences in serum cholesterol. However, cholesterol-adjusted vitamin E levels were low in the three high CHD areas: Scotland 3.41 (2.41-4.62); north Karelia 3.53 (2.67-5.18); south-west Finland 3.53 (2.58-4.92); Italy 4.81 (3.25-5.99) mumol/mmol cholesterol (P less than 0.001). Cholesterol-adjusted vitamin E was not lower in north Karelia, the higher CHD mortality area in Finland. Serum selenium values also varied with the area examined and reported low levels in Finland were confirmed. Nevertheless, selenium levels did not correlate with the reported mortality rates of CHD. Thus in our small cross-cultural study the evidence did not support our hypothesis that plasma antioxidants explain regional differences in CHD mortality.