Circulation, Vol 90, 1154-1161, Copyright © 1994 by American Heart Association
DA Street, GW Comstock, RM Salkeld, W Schuep and MJ Klag
BACKGROUND: In vitro, animal and epidemiological studies suggest that
lipoprotein oxidation may play an important role in atherosclerosis.
Antioxidants may protect against lipoprotein oxidation and in that way
inhibit atherosclerosis and its clinical sequelae. To investigate this
possibility, we examined the association between levels of several
antioxidants and myocardial infarction using serum specimens collected 7 to
14 years before the onset of myocardial infarction. METHODS AND RESULTS: A
nested case-control design was used. Cases and control subjects were
selected from the 25,802 persons who had donated 15 mL of blood in 1974 for
a serum bank. Cases comprised 123 persons with a subsequent first diagnosis
of myocardial infarction who ranged from 23 through 58 years of age in 1974
and who had had their first diagnosis of myocardial infarction during 1981
to 1988. Two groups of control subjects matched to the cases for sex and
age were selected from donors to the serum bank, one from those with
hospital admissions during the same period and the other from the total
group of donors. Sera were assayed for four carotenoids (beta-carotene,
lycopene, lutein, and zeaxanthin), alpha-tocopherol, and cholesterol.
Because associations with these serum nutrients showed similar trends
whether based on hospital or community controls, the two control groups
were combined. There was a significantly increasing risk for subsequent
myocardial infarction with decreasing levels of beta-carotene in 1974 (P
value for trend, .02) and a suggestive trend with decreasing levels of
lutein (P = .09). When the results were stratified by smoking status, the
excess risk of myocardial infarction associated with low serum levels of
carotenoids was limited to smokers. A protective association with higher
levels of alpha-tocopherol was suggested only among persons with high
levels of serum cholesterol. CONCLUSIONS: Low serum levels of carotenoids
were associated with an increased risk of subsequent myocardial infarction
among smokers.
ARTICLES
Serum antioxidants and myocardial infarction. Are low levels of carotenoids and alpha-tocopherol risk factors for myocardial infarction?
Department of Epidemiology, Johns Hopkins University School of Hygiene and Public Health, Baltimore, Md.
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