Scientific Study

BACKGROUND. The oxidative modification of low-density lipoproteins increases their incorporation into the arterial intima; an essential step in atherogenesis. Although dietary antioxidants; such as vitamin C; carotene; and vitamin E; have been hypothesized to prevent coronary heart disease; prospective epidemiologic data are sparse. METHODS. In 1986; 39;910 U.S. male health professionals 40 to 75 years of age who were free of diagnosed coronary heart disease; diabetes; and hypercholesterolemia completed detailed dietary questionnaires that assessed their usual intake of vitamin C; carotene; and vitamin E in addition to other nutrients. During four years of follow-up; we documented 667 cases of coronary disease. RESULTS. After controlling for age and several coronary risk factors; we observed a lower risk of coronary disease among men with higher intakes of vitamin E (P for trend = 0.003). For men consuming more than 60 IU per day of vitamin E; the multivariate relative risk was 0.64 (95 percent confidence interval; 0.49 to 0.83) as compared with those consuming less than 7.5 IU per day. As compared with men who did not take vitamin E supplements; men who took at least 100 IU per day for at least two years had a multivariate relative risk of coronary disease of 0.63 (95 percent confidence interval; 0.47 to 0.84). Carotene intake was not associated with a lower risk of coronary disease among those who had never smoked; but it was inversely associated with the risk among current smokers (relative risk; 0.30; 95 percent confidence interval; 0.11 to 0.82) and former smokers (relative risk; 0.60; 95 percent confidence interval; 0.38 to 0.94). In contrast; a high intake of vitamin C was not associated with a lower risk of coronary disease. CONCLUSIONS. These data do not prove a causal relation; but they provide evidence of an association between a high intake of vitamin E and a lower risk of coronary heart disease in men. Public policy recommendations with regard to the use of vitamin E supplements should await the results of additional studies.