 |
 |
|
| |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
15 June 1999 | Volume 130 Issue 12 | Pages 963-970
Background: Antioxidants increase the resistance of low-density lipoprotein to oxidation and may thereby reduce risk for atherosclerosis.
Objective: To determine whether intake of vitamin E, vitamin C, or carotenoids predict risk for total or ischemic stroke.
Design: Prospective observational study.
Setting: The Health Professionals Follow-up Study.
Participants: 43 738 men 40 to 75 years of age who did not have cardiovascular disease or diabetes.
Measurements: Repeated and validated dietary assessments were done by using a self-administered 131-item food-frequency questionnaire, which included questions on dose and duration of vitamin supplement use. The follow-up period was 8 years.
Results: A total of 328 strokes occurred: 210 ischemic, 70 hemorrhagic, and 48 unclassified. After adjustment for age, smoking, hypertension, hypercholesterolemia, body mass index, physical activity, parental history of myocardial infarction, alcohol consumption, and total energy intake, the relative risk for ischemic stroke in the top quintile of vitamin E intake (median, 411 IU/d) compared with the bottom quintile (5.4 IU/d) was 1.18 (95% CI, 0.77 to 1.82). The relative risk for ischemic stroke in the top quintile of vitamin C intake (1167 mg/d) compared with the bottom quintile (95 mg/d) was 1.03 (CI, 0.66 to 1.59). Results for total stroke were similar. Associations of vitamin intake with hemorrhagic stroke were also nonsignificant, but the CIs were wide. Neither dose nor duration of vitamin E or vitamin C supplement use was related to risk for total or ischemic stroke. The relative risk for ischemic stroke was 1.16 (CI, 0.81 to 1.67) in men using 250 IU or more of vitamin E supplementation per day compared with men who used no vitamin E supplements and was 0.93 (CI, 0.60 to 1.45) in men using 700 mg or more of vitamin C supplementation per day compared with men who used no vitamin C supplements. A significant inverse relation between lutein intake and risk for ischemic stroke was seen but was not independent of other dietary factors.
Conclusions: Vitamin E and vitamin C supplements and specific carotenoids did not seem to substantially reduce risk for stroke in this cohort. Modest effects, however, cannot be excluded.
Author and Article Information
From Harvard School of Public Health, Harvard Medical School, and Brigham and Women's Hospital, Boston, Massachusetts.
Acknowledgments: The authors thank the participants of the Health Professionals Follow-up Study. They also thank Al Wing, Mira Kaufman, Karen Corsano, and Steve Stuart for computer assistance; Jill Arnold, Betsy Frost-Hawes, Kerry Demers, and Mitzi Wolff for assistance with compilation of data and manuscript preparation; and Laura Sampson and Helaine Rockett for maintaining food composition tables.
Grant Support: In part by research grants HL 35464 and CA 55075 from the National Institutes of Health. Dr. Kawachi is supported by a Career Development Award from the National Heart, Lung, and Blood Institute.
Requests for Reprints: Alberto Ascherio, MD, Department of Nutrition, Harvard School of Public Health, 665 Huntington Avenue, Boston, MA 02115; e-mail, alberto.ascherio{at}channing.harvard.edu.
Current Author Addresses: Drs. Ascherio, Hernán, Rimm, and Willett: Department of Nutrition, Harvard School of Public Health, 665 Huntington Avenue, Boston, MA 02115.
Drs. Giovannucci and Stampfer: Channing Laboratory, Department of Medicine, Harvard Medical School and Brigham and Women's Hospital, 181 Longwood Avenue, Boston, MA 02115.
Dr. Kawachi: Department of Health and Social Behavior, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115. ARTICLE
Relation of Consumption of Vitamin E, Vitamin C, and Carotenoids to Risk for Stroke among Men in the United States
This article has been cited by other articles:
|
|
 |
|
  H. D. Sesso, J. E. Buring, W. G. Christen, T. Kurth, C. Belanger, J. MacFadyen, V. Bubes, J. E. Manson, R. J. Glynn, and J. M. Gaziano Vitamins E and C in the Prevention of Cardiovascular Disease in Men: The Physicians' Health Study II Randomized Controlled Trial JAMA, November 12, 2008; 300(18): 2123 - 2133. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. K Myint, R. N Luben, A. A Welch, S. A Bingham, N. J Wareham, and K.-T. Khaw Plasma vitamin C concentrations predict risk of incident stroke over 10 y in 20 649 participants of the European Prospective Investigation into Cancer Norfolk prospective population study Am. J. Clinical Nutrition, January 1, 2008; 87(1): 64 - 69. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Voutilainen, T. Nurmi, J. Mursu, and T. H Rissanen Carotenoids and cardiovascular health Am. J. Clinical Nutrition, June 1, 2006; 83(6): 1265 - 1271. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. H.K. Vogel, S. F. Bolling, R. B. Costello, E. M. Guarneri, M. W. Krucoff, J. C. Longhurst, B. Olshansky, K. R. Pelletier, C. M. Tracy, R. A. Vogel, et al. Integrating Complementary Medicine Into Cardiovascular Medicine: A Report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents (Writing Committee to Develop an Expert Consensus Document on Complementary and Integrative Medicine) J. Am. Coll. Cardiol., July 5, 2005; 46(1): 184 - 221. [Full Text] [PDF]
|
|
|
|
 |
|
 L. Yanes, D. Romero, R. Iliescu, V. E. Cucchiarelli, L. A. Fortepiani, F. Santacruz, W. Bell, H. Zhang, and J. F. Reckelhoff Systemic arterial pressure response to two weeks of Tempol therapy in SHR: involvement of NO, the RAS, and oxidative stress Am J Physiol Regulatory Integrative Comp Physiol, April 1, 2005; 288(4): R903 - R908. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. A Vinson, L. Zubik, P. Bose, N. Samman, and J. Proch Dried Fruits: Excellent in Vitro and in Vivo Antioxidants J. Am. Coll. Nutr., February 1, 2005; 24(1): 44 - 50. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. R. Trumbo The Level of Evidence for Permitting a Qualified Health Claim: FDA's Review of the Evidence for Selenium and Cancer and Vitamin E and Heart Disease J. Nutr., February 1, 2005; 135(2): 354 - 356. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. D. Ribaya-Mercado and J. B. Blumberg Lutein and Zeaxanthin and Their Potential Roles in Disease Prevention J. Am. Coll. Nutr., December 1, 2004; 23(suppl_6): 567S - 587S. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. Yang, L. J. Roberts, M. J. Shi, L. C. Zhou, B. R. Ballard, A. Richardson, and Z. M. Guo Retardation of Atherosclerosis by Overexpression of Catalase or Both Cu/Zn-Superoxide Dismutase and Catalase in Mice Lacking Apolipoprotein E Circ. Res., November 26, 2004; 95(11): 1075 - 1081. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. E. Hak, J. Ma, C. B. Powell, H. Campos, J. M. Gaziano, W. C. Willett, and M. J. Stampfer Prospective Study of Plasma Carotenoids and Tocopherols in Relation to Risk of Ischemic Stroke Stroke, July 1, 2004; 35(7): 1584 - 1588. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. He, A. Merchant, E. B. Rimm, B. A. Rosner, M. J. Stampfer, W. C. Willett, and A. Ascherio Folate, Vitamin B6, and B12 Intakes in Relation to Risk of Stroke Among Men Stroke, January 1, 2004; 35(1): 169 - 174. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. D. Sesso, S. Liu, J. M. Gaziano, and J. E. Buring Dietary Lycopene, Tomato-Based Food Products and Cardiovascular Disease in Women J. Nutr., July 1, 2003; 133(7): 2336 - 2341. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. J. Padayatty, A. Katz, Y. Wang, P. Eck, O. Kwon, J.-H. Lee, S. Chen, C. Corpe, A. Dutta, S. K Dutta, et al. Vitamin C as an Antioxidant: Evaluation of Its Role in Disease Prevention J. Am. Coll. Nutr., February 1, 2003; 22(1): 18 - 35. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. He, E. B. Rimm, A. Merchant, B. A. Rosner, M. J. Stampfer, W. C. Willett, and A. Ascherio Fish Consumption and Risk of Stroke in Men JAMA, December 25, 2002; 288(24): 3130 - 3136. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. Rissanen, S. Voutilainen, K. Nyyssonen, and J. T. Salonen Lycopene, Atherosclerosis, and Coronary Heart Disease Experimental Biology and Medicine, November 1, 2002; 227(10): 900 - 907. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Iannuzzi, E. Celentano, S. Panico, R. Galasso, G. Covetti, L. Sacchetti, F. Zarrilli, M. De Michele, and P. Rubba Dietary and circulating antioxidant vitamins in relation to carotid plaques in middle-aged women Am. J. Clinical Nutrition, September 1, 2002; 76(3): 582 - 587. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. P. Jarvik, N. T. Tsai, L. A. McKinstry, R. Wani, V. H. Brophy, R. J. Richter, G. D. Schellenberg, P. J. Heagerty, T. S. Hatsukami, and C. E. Furlong Vitamin C and E Intake Is Associated With Increased Paraoxonase Activity Arterioscler. Thromb. Vasc. Biol., August 1, 2002; 22(8): 1329 - 1333. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. B. Feldman The Scientific Evidence for a Beneficial Health Relationship Between Walnuts and Coronary Heart Disease J. Nutr., May 1, 2002; 132(5): 1062S - 1101. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. B. Gorelick Stroke Prevention Therapy Beyond Antithrombotics: Unifying Mechanisms in Ischemic Stroke Pathogenesis and Implications for Therapy: An Invited Review Stroke, March 1, 2002; 33(3): 862 - 875. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. A. Dillon, G. M. Lowe, D. Billington, and K. Rahman Dietary Supplementation with Aged Garlic Extract Reduces Plasma and Urine Concentrations of 8-Iso-Prostaglandin F2{alpha} in Smoking and Nonsmoking Men and Women J. Nutr., February 1, 2002; 132(2): 168 - 171. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 W. C. Willett and M. J. Stampfer What Vitamins Should I Be Taking, Doctor? N. Engl. J. Med., December 20, 2001; 345(25): 1819 - 1824. [Full Text] [PDF]
|
|
|
|
 |
|
 L. M. Jampol Antioxidants, Zinc, and Age-Related Macular Degeneration: Results and Recommendations Arch Ophthalmol, October 1, 2001; 119(10): 1533 - 1534. [Full Text] [PDF]
|
|
|
|
 |
|
 R. M. Robertson and L. Smaha Can a Mediterranean-Style Diet Reduce Heart Disease? Circulation, April 3, 2001; 103(13): 1821 - 1822. [Full Text] [PDF]
|
|
|
|
|
|
L. B. Goldstein, R. Adams, K. Becker, C. D. Furberg, P. B. Gorelick, G. Hademenos, M. Hill, G. Howard, V. J. Howard, B. Jacobs, et al. Primary Prevention of Ischemic Stroke : A Statement for Healthcare Professionals From the Stroke Council of the American Heart Association Circulation, January 2, 2001; 103(1): 163 - 182. [Full Text] [PDF]
|
|
|
|
|
|
L. B. Goldstein, R. Adams, K. Becker, C. D. Furberg, P. B. Gorelick, G. Hademenos, M. Hill, G. Howard, V. J. Howard, B. Jacobs, et al. Primary Prevention of Ischemic Stroke : A Statement for Healthcare Professionals From the Stroke Council of the American Heart Association Stroke, January 1, 2001; 32(1): 280 - 299. [Full Text] [PDF]
|
|
|
|
|
|
R. M. Krauss, R. H. Eckel, B. Howard, L. J. Appel, S. R. Daniels, R. J. Deckelbaum, J. W. Erdman Jr, P. Kris-Etherton, I. J. Goldberg, T. A. Kotchen, et al. AHA Scientific Statement: AHA Dietary Guidelines: Revision 2000: A Statement for Healthcare Professionals From the Nutrition Committee of the American Heart Association J. Nutr., January 1, 2001; 131(1): 132 - 146. [Full Text]
|
|
|
|
|
|
R. M. Krauss, R. H. Eckel, B. Howard, L. J. Appel, S. R. Daniels, R. J. Deckelbaum, J. W. Erdman Jr, P. Kris-Etherton, I. J. Goldberg, T. A. Kotchen, et al. AHA Dietary Guidelines : Revision 2000: A Statement for Healthcare Professionals From the Nutrition Committee of the American Heart Association Stroke, November 1, 2000; 31(11): 2751 - 2766. [Full Text] [PDF]
|
|
|
|
|
|
R. M. Krauss, R. H. Eckel, B. Howard, L. J. Appel, S. R. Daniels, R. J. Deckelbaum, J. W. Erdman Jr, P. Kris-Etherton, I. J. Goldberg, T. A. Kotchen, et al. AHA Dietary Guidelines : Revision 2000: A Statement for Healthcare Professionals From the Nutrition Committee of the American Heart Association Circulation, October 31, 2000; 102(18): 2284 - 2299. [Full Text] [PDF]
|
|
|
|
|
|
T. Hirvonen, J. Virtamo, P. Korhonen, D. Albanes, and P. Pietinen Intake of Flavonoids, Carotenoids, Vitamins C and E, and Risk of Stroke in Male Smokers Stroke, October 1, 2000; 31(10): 2301 - 2306. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. Halliwell Lipid peroxidation, antioxidants and cardiovascular disease: how should we move forward? Cardiovasc Res, August 18, 2000; 47(3): 410 - 418. [Full Text] [PDF]
|
|
|
|
|
|
A. Ascherio Antioxidants and stroke Am. J. Clinical Nutrition, August 1, 2000; 72(2): 337 - 338. [Full Text] [PDF]
|
|
|
|
 |
|
 P. C. Amadio Commentary J. Bone Joint Surg. Am., June 1, 2000; 82(6): 873-a - 873. [Full Text]
|
|
|
|
 |
|
 Do Vitamin E, Vitamin C, and Carotenoids Reduce Stroke Risk? Journal Watch Cardiology, September 10, 1999; 1999(910): 1 - 1. [Full Text]
|
|
|
|
 |
|
 Antioxidants Unlikely to Prevent Stroke Journal Watch (General), July 2, 1999; 1999(702): 5 - 5. [Full Text]
|
|
|
|
 |
|
 F. Davidoff Standing Statistics Right Side Up Ann Intern Med, June 15, 1999; 130(12): 1019 - 1021. [Full Text] [PDF]
|
|
|
|
|
|
Y. Nakata and N. Maeda Vulnerable Atherosclerotic Plaque Morphology in Apolipoprotein E-Deficient Mice Unable to Make Ascorbic Acid Circulation, March 26, 2002; 105(12): 1485 - 1490. [Abstract] [Full Text] [PDF]
|
|
Article
