Lack of an association between serum vitamin E and myocardial infarction in a population with high vitamin E levels

  • Hans W. Hense
    Corresponding author, GSF-Institut fu¨r Epidemiologie, Neuherberg, Postfach 1129, D-85758 Oberschleissheim, Germany.
    GSF - Forschungszentrum fu¨r Umwelt und Gesundheit, Institut fu¨r Epidemiologie, Neuherberg, Postfach 1129, D-85758 Oberschleissheim, Germany

    Ruhr Universita¨t Bochum, Abteilung fu¨r Sozial Medizin and Epidemiologie, Bochum, Germany
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  • Monika Stender
    GSF - Forschungszentrum fu¨r Umwelt und Gesundheit, Institut fu¨r Epidemiologie, Neuherberg, Postfach 1129, D-85758 Oberschleissheim, Germany
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  • Wolf Borsc
    GSF - Forschungszentrum fu¨rr Umwelt and Gesundheit, Institut fu¨r Strahlenbiologie, Neuherberg, Germany
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  • Ulrich Keil
    GSF - Forschungszentrum fu¨r Umwelt und Gesundheit, Institut fu¨r Epidemiologie, Neuherberg, Postfach 1129, D-85758 Oberschleissheim, Germany

    Institut fu¨r Epidemiologie und Sozialmedizin, Westfa¨lische Wilhelms-Universita¨t, Mu¨nster, Germany
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      The antioxidant effects of vitamin E may protect low density lipoproteins from peroxidation and thus inhibit the development of arteriosclerosis. Inverse associations between vitamin E levels and coronary heart disease have been reported from cross-sectional and ecologic studies. In the population-based MONICA Augsburg cohort (2023 men, 1999 women, age 25–64 years at baseline in 1984, 93% of whom were reexamined in 1987/1988) we investigated the relationship between serum vitamin E concentrations and the risk of subsequent myocardial infarction (MI). Between 1984 and 1991, 46 cases of fatal and non-fatal myocardial infarction from this cohort were recruited for a nested case-control study. Four controls were sampled from the cohort for each case of MI with matching for age, sex, and total cholesterol. There were no marked differences between cases and their matched controls in the means of vitamin E concentrations (33.9 μmol/l vs. 32.8 μmol/l, P = 0.37) or in the mean vitamin E/total cholesterol ratios (4.89 μmol/mmol vs. 4.82 μmol/mmol, P = 0.75). The covariate adjusted relative risk (RR) for fatal plus non-fatal MI in the lowest tertile of vitamin E relative to the upper two tertiles was 0.72 (90% confidence interval: 0.33–1.57). Likewise, for the lowest tertile of the ratio (vitamin E/total cholesterol) the RR was 0.81 (0.42–1.56). The association was not modified by history of previous coronary heart disease, fatality of MI, temporal distance of MI onset from vitamin E determinations, or season. Although the limited statistical power of this study has to be considered, risk estimates appeared too low to be compatible with a substantial protective effect of vitamin E levels. We conclude, therefore, that serum vitamin E concentrations were not associated with the myocardial infarction risk and suggest that this is probably due to the high average levels of vitamin E in our study population.


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        • Ross R.
        The pathogenesis of atherosclerosis — an update.
        N. Engl. J. Med. 1986; 314: 488
        • Steinberg D.
        • Parthasarathy S.
        • Carew T.E.
        • Khoo J.C.
        • Witztum J.L.
        Beyond cholesterol — modifications of low-density lipoprotein that increase its atherogenicity.
        N. Engl. J. Med. 1989; 320: 915
        • Luc G.
        • Fruchart J.C.
        Oxidation of lipoproteins and atherosclerosis.
        Am. J. Clin. Nutr. 1991; 53: 206S
        • Salonen J.T.
        • Yla¨-Herttuala S.
        • Yamamoto R.
        • Butler S.
        • Korpela H.
        • Salonen R.
        • Nyysso¨nen K.
        • Palinski W.
        • Witztum J.L.
        Autoantibody against oxised LDL and regression of carotid atherosclerosis.
        Lancet. 1992; 339: 883
        • Regnstro¨m J.
        • Nilsson J.
        • Tornvall P.
        • Landon C.
        • Hamsten A.
        Susceptibility to low-density lipoprotein peroxidation and coronary atherosclerosis in man.
        Lancet. 1992; 339: 1183
        • Di Mascio P.
        • Murphy M.E.
        • Sies H.
        Antioxidant defense systems: the role of carotenoids, tocopherols, and thiols.
        Am. J. Clin. Nutr. 1991; 53: 194S
        • Riemersma R.A.
        • Wood D.A.
        • MacIntyre C.C.A.
        • Elton R.A.
        • Gey K.F.
        • Oliver M.F.
        Risk of angina pectoris and plasma concentrations of vitamins A, C, and E and carotene.
        Lancet. 1991; 337: 1
        • Gey F.K.
        • Puska P.
        • Jordan P.
        • Moser U.K.
        Inverse correlation between plasma vitamin E and mortality from ischemic heart disease in cross-cultural epidemiology.
        Am. J. Clin. Nutr. 1991; 53: 326S
        • Salonen J.T.
        • Salonen R.
        • Seppa¨nen K.
        • Kantola M.
        • Parviainen M.
        • Alfthan G.
        • Ma¨enpa¨a¨ P.H.
        • Taskinen E.
        • Rauramaa R.
        Relationship of serum selenium and antioxidants to plasma lipoproteins, platelet aggregability and prevalent ischemic heart disease in Eastern Finnish men.
        Atherosclerosis. 1988; 70: 155
        • Riemersma R.A.
        • Oliver M.
        • Elton R.A.
        • Alfthan G.
        • Vartiainen E.
        • Salo M.
        • Rubba P.
        • Mancini M.
        • Georgi H.
        • Vuilleumier J.P.
        • Gey K.F.
        Plasma antioxidants and coronary heart disease: vitamins C and E, and selenium.
        Eur. J. Clin. Nutr. 1990; 44: 143
        • Salonen J.T.
        • Salonen R.
        • Penttila¨ I.
        • Herranen J.
        • Jauhiainen M.
        • Kantola M.
        • Lappetelainen R.
        • Ma¨enpa¨a¨ P.H.
        • Alfthan G.
        • Puska P.
        Serum fatty acids, apolipoproteins, selenium and vitamin antioxidants and the risk of death from coronary artery disease.
        Am. J. Cardiol. 1985; 56: 226
        • Kok F.J.
        • de Bruijn A.M.
        • Vermeeren R.
        • Hofman A.
        • van Laar A.
        • de Bruin M.
        • Hermus R.H.
        • Valkenburg H.A.
        Serum selenium, vitamin antioxidants, and cardiovascular mortality: a 9-year follow-up study in the Netherlands.
        Am. J. Clin. Nutr. 1987; 45: 462
        • Lo¨wel H.
        • Lewis M.
        • Ho¨rmann A.
        • Keil U.
        Case finding, data quality aspects and comparability of myocardial infarction registers: results of a South German register study.
        J. Clin. Epidemiol. 1991; 44: 249
        • WHO MONICA Project
        WHO MONICA Project: assessing IHD mortality and morbidity.
        Int. J. Epidemiol. 1989; 18 (prepared by Tuomilehto, J. and Kuulasmaa, K.): S38
        • Keil U.
        • Stieber J.
        • Do¨ring A.
        • Chambless L.
        • Ha¨rtel U.
        • Filipiak B.
        • Hense H.W.
        • Tietze M.
        • Gostomzyk J.
        The cardiovascular risk factor profile in the study area Augsburg. Results from the first MONICA survey 1984/1985.
        Acta. Med. Scand. 1988; : 119
        • Vuilleumier J.P.
        • Keller H.E.
        • Glysel D.
        • Hunziker F.
        Clinical chemical methods for the routine assessment of the vitamin status in human populations. Part I: the fatsoluble vitamins A and E, and β-carotene.
        Int. J. Vit. Nutr. Res. 1983; 53: 265
        • Hense H.W.
        • Do¨ring A.
        • Stieber J.
        • Keil U.
        The association of antihypertensive treatment patterns and adverse lipid effects in population-based studies.
        J. Clin. Epidemiol. 1992; 45: 1423
        • Keil U.
        • Chambless L.
        • Filipiak B.
        • Ha¨rtel U.
        Alcohol and blood pressure and its interaction with smoking and other behavioral variables: results from the MONICA Augsburg survey 1984–1985.
        J. Hypertens. 1991; 9: 491
        • Kleinbaum D.
        • Kupper L.L.
        • Morgenstern H.
        Epidemiologic Research. Principles and Quantitative Methods.
        Lifetime Learning Publications, Belmont, CA1982 (Chapter 24)
        • Lo¨wel H.
        • Lewis M.
        • Ho¨rmann A.
        Prognostic significance of the prehospital phase for survival after acute myocardial infarction (in German).
        Dtsch. Med. Wochenschr. 1991; 116: 729
        • Gunter E.W.
        • Driskell W.J.
        • Yeager P.R.
        Stability of vitamin E in long-term stored serum.
        Clin. Chim. Acta. 1988; 175: 329
        • Heseker H.
        • Schneider R.
        • Moch K.J.
        • Kohlmeier M.
        • Ku¨bler W.
        Vitaminversorgung Erwachsener in der Bundesrepublik Deutschland.
        in: Ku¨bler W. Band IV of the VERA-Schriftenreihe. Wissenschaftlicher Fachverlag, Giessen, Germany1992
        • Gey K.F.
        Vitamin E and other essential antioxidants regarding coronary heart disease: risk assessment studies. Epidemiological basis of the antioxidant hypothesis of cardiovascular disease.
        in: Packer L. Fuchs J. Vitamin E in Health and Disease. Marcel Dekker, New York1992: 589
        • Gey K.F.
        • Sta¨helin H.B.
        • Eichholzer M.
        Poor plasma status of carotene and vitamin C is associated with higher mortality from ischemic heart disease and stroke: Basel Prospective Study.
        Clin. Invest. 1993; 71: 3
        • Harats D.
        • Ben-Naim M.
        • Dabach Y.
        • Hollander C.
        • Havivi E.
        • Stein O.
        • Stein Y.
        Effect of vitamin C and E supplementation on susceptibility of plasma lipo proteins to peroxidation induced by acute smoking.
        Atherosclerosis. 1990; 85: 47
        • Winkler G.
        • Do¨ring A.
        • Keil U.
        • Pietinen P.
        • Arveiler D.
        • Cambou J.P.
        • Richard J.L.
        • Evans A.
        • McClean R.
        • McCrum E.
        Comparison of dietary intakes in four selected European populations.
        Clin. Invest. 1992; 70: 889
        • Meade T.W.
        Thrombosis and cardiovascular disease.
        Ann. Epidemiol. 1992; 2: 353
        • Steinberg D.
        • Workshop Participants
        Antioxidants in the prevention of human atherosclerosis.
        in: Summary of the proceedings of a National Heart, Lung, and Blood Institute Workshop. 4th Edn. Circulation. 85. 1992: 2338