Clinical research study
Total Antioxidant Capacity from Diet and Risk of Myocardial Infarction: A Prospective Cohort of Women

https://doi.org/10.1016/j.amjmed.2012.03.008Get rights and content

Abstract

Background

There are no previous studies investigating the effect of all dietary antioxidants in relation to myocardial infarction. The total antioxidant capacity of diet takes into account all antioxidants and synergistic effects between them. The aim of this study was to examine how total antioxidant capacity of diet and antioxidant-containing foods were associated with incident myocardial infarction among middle-aged and elderly women.

Methods

In the population-based prospective Swedish Mammography Cohort of 49-83-year-old women, 32,561 were cardiovascular disease-free at baseline. Women completed a food-frequency questionnaire, and dietary total antioxidant capacity was calculated using oxygen radical absorbance capacity values. Information on myocardial infarction was identified from the Swedish Hospital Discharge and the Cause of Death registries. Hazard ratios (HR) and 95% confidence intervals (CI) were calculated using Cox proportional hazard models.

Results

During the follow-up (September 1997-December 2007), we identified 1114 incident cases of myocardial infarction (321,434 person-years). In multivariable-adjusted analysis, the HR for women comparing the highest quintile of dietary total antioxidant capacity to the lowest was 0.80 (95% CI, 0.67-0.97; P for trend = 0.02). Servings of fruit and vegetables and whole grains were nonsignificantly inversely associated with myocardial infarction.

Conclusions

These data suggest that dietary total antioxidant capacity, based on fruits, vegetables, coffee, and whole grains, is of importance in the prevention of myocardial infarction.

Section snippets

Ethics Statement

The Regional Ethical Review Board at Karolinska Institutet (Stockholm, Sweden) approved this investigation, and return of the self-administrated questionnaire was considered to imply informed consent to participate in the study.

Study Population

The Swedish Mammography Cohort was established between 1987 and 1990 among women residing in the Uppsala and Västmanland counties in central Sweden. All women born 1914-1948 were sent a questionnaire concerning diet, educational level, weight and height, and reproductive

Results

During the average 9.9 years of follow-up (321,434 person-years), we identified 1114 cases of incident myocardial infarction (the average age of first myocardial infarction was 75.7 years). Baseline characteristics of the women are presented in Table 1. Women with higher total antioxidant capacity of diet were more likely to be nonsmokers, have ≥12 years of education, and to have hypercholesterolemia. Regarding dietary characteristics, women in the highest quintile of total antioxidant capacity

Discussion

In this large prospective population-based cohort study, we observed that higher total antioxidant capacity of diet was statistically significantly associated with lower risk of incident myocardial infarction in a dose-response manner. Consumption of antioxidant-containing foods such as fruits and vegetables and whole grains were nonsignificantly inversely associated with the risk of myocardial infarction.

To our knowledge, this is the first study investigating dietary total antioxidant capacity

References (36)

  • V. Darley-Usmar et al.

    Blood radicals: reactive nitrogen species, reactive oxygen species, transition metal ions, and the vascular system

    Pharm Res

    (1996)
  • A. Csiszar et al.

    Inflammation and endothelial dysfunction during aging: role of NF-kappaB

    J Appl Physiol

    (2008)
  • S. de Ferranti et al.

    The perfect storm: obesity, adipocyte dysfunction, and metabolic consequences

    Clin Chem

    (2008)
  • R.M. Touyz

    Reactive oxygen species, vascular oxidative stress, and redox signaling in hypertension: what is the clinical significance?

    Hypertension

    (2004)
  • H.D. Sesso et al.

    Vitamins E and C in the prevention of cardiovascular disease in men: the Physicians' Health Study II randomized controlled trial

    JAMA

    (2008)
  • I.M. Lee et al.

    Vitamin E in the primary prevention of cardiovascular disease and cancer: the Women's Health Study: a randomized controlled trial

    JAMA

    (2005)
  • E. Lonn et al.

    Effects of long-term vitamin E supplementation on cardiovascular events and cancer: a randomized controlled trial

    JAMA

    (2005)
  • N.R. Cook 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)
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    Funding: The study was supported by the Swedish Research Council for Infrastructure and the Swedish Council for Working Life and Social Research. The funders have not played a role in the study design, data collection, analysis, decision to publish, or preparation of the manuscript.

    Conflict of Interest: None.

    Authorship: All authors had access to the data and a role in writing the manuscript.

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