The antioxidants you get from eating a healthy diet with plenty of fruit, veggies, whole grains, beans, legumes, and nuts are a big part of a heart-healthy lifestyle. Antioxidants work to deactivate free radicals by binding to oxidants, which prevents damage from free radicals.

Below is a list of the best food sources for some of the most important antioxidant nutrients. Vitamin E prevents the peroxidation of polyunsaturated fatty acid in membranes.

Vitamin E is found in:. Selenium may provide protection against CHD and selenium levels are inversely associated with CHD mortality.

Foods that contain selenium include:. Beta carotene is a vitamin A precursor carried in plasma and LDL. Good sources of beta carotene include:.

Good sources of lycopene include:. Research also shows that lycopene is better absorbed by our bodies when heated and combined with healthy fats such as olive and coconut oil. Some great ways to get the best absorption of these lycopene-rich foods are through recipes like:.

Resveratrol, which is found in red wine, is an antioxidant that may help prevent CHD. The potential heart-healthy benefits of red wine and other alcoholic drinks look promising. Those who drink moderate amounts of alcohol, including red wine, seem to have a lower risk of heart disease.

Alcohol can be addictive and cause other health problems. Astaxanthin antioxidant properties include being linked to improved blood flow and lowering oxidative stress in smokers and overweight people. A comparison study of astaxanthin and other carotenoids showed that it displayed the highest antioxidant activity against free radicals.

Astaxanthin is most commonly found in:. Are High Fat Foods Good for Your Heart? Intervention studies provide the best evidence of causality; however, their results can often only be generalized to a limited extent.

Conclusions as to the causality of a link are drawn from the sum of all studies. This provides a more or less probable overall body of evidence. Diet-related effects may, however, be an indicator of another underlying process or influencing factor without being directly involved in the occurrence of chronic diseases.

Finally, conclusions are also influenced by results from animal experiments and studies on cell cultures into possible mechanisms. Results from epidemiological studies. Results from case-control and cohort studies indicate that the antioxidant vitamins C and E and also beta-carotene could have an important role to play in the primary prevention of cardiovascular disease.

Antioxidants in the studies were found to be most effective in the early stages of atherosclerosis — the cause of heart attacks, stroke and peripheral vascular disease. Those with low levels of vitamins C and E and beta-carotene will benefit especially from a higher intake of these micronutrients.

If intake of antioxidants or blood levels in a whole study population were in the optimal range or higher, there was usually no discernable additional risk reduction. Today it is thought that a reduction in the risk of developing such complex chronic diseases is achieved through the interaction of a number of different factors across the lifestyle spectrum circumstances and habits.

A prerequisite for this appears to be optimal intake together with correspondingly high plasma levels. The antioxidants act in combination, and are interchangeable to only a limited degree. Influence of antioxidant supplementation and blood concentrations on cardiovascular disease:.

The risk for coronary heart disease was reduced by around 20 percent. The First National Health and Nutrition Examination Survey Epidemiologic Follow-up Study with a cohort of more than 11, adults showed a reduction in cardiovascular mortality of 42 percent for men and 25 percent for women who consumed at least 50 mg vitamin C daily in the diet and also regularly took supplements containing vitamin C 2.

In three large-scale prospective cohort studies on men and women an association was observed between increased intake of vitamin E and a reduced risk of coronary heart disease.

A study involving 87, nurses revealed a risk reduction for coronary heart disease with daily consumption of food supplements containing vitamin E at a dose of more than IU for at least two years 6. However, in this study only a few women consumed large doses of vitamin E. A further study found a non-significant reduction in coronary heart disease risk both with total vitamin E intake and with supplement consumption 5.

A study with data from 16 European countries showed that low vitamin E blood levels are linked to an increased risk of dying of cardiovascular diseases 8.

In the MONICA Augsburg Study 9 cohort study, no evidence was found of a significant association between vitamin E blood levels and myocardial infarction. The preventive effect also depended on smoking status: it was observed only for current or former smokers, not for people who have never smoked.

In a cohort study of postmenopausal women no reduction in cardiovascular disease risk was found 7. Regarding blood levels of beta-carotene, after exclusion of 3 study locations with anomalous values all Finnish locations a study of healthy men from 16 study locations in Europe showed a clear association between low plasma concentrations of beta-carotene and a higher rate of mortality from ischemic heart disease 8.

Men in the Basel Prospective Study cohort who had had low baseline beta-carotene blood concentrations were at increased risk of mortality from stroke over the year study period 11, Results from meta-analyses of epidemiological studies into the reduction of risk of cardiovascular disease through increased intake of antioxidant micronutrients in the diet or as food supplements diverge in some cases — as do those from the studies they examine.

Protective effects of varying degrees were established for individual antioxidants. This is not surprising, since the observations were made in different study populations who had consumed varying amounts and doses of micronutrients, singly or in combination.

Critical review of these studies — alone or in the context of a meta-analysis — shows that many study participants were already well supplied with antioxidant micronutrients in their diet. Thus no further risk reduction was to be expected from the consumption of food supplements.

Moreover, many study participants already had a health problem, meaning there was no longer an option for primary prevention through antioxidants.

Meta-analysis of 15 cohort studies on the consumption of vitamins C and E and beta-carotene revealed a significantly reduced risk for coronary heart disease with a high intake of vitamins C and E in the diet Consumption of food supplements was associated with a risk reduction only for vitamin E.

An analysis of 9 cohort studies revealed a significant reduction in the risk of coronary heart disease through supplementation with vitamin C Risk reductions through increased beta-carotene and vitamin E intake were comparatively modest. In a further meta-analysis, increased intake from fruit and vegetables resulted in a reduced risk of coronary heart disease in smokers Analysis of the results from two large cohort studies showed that increased consumption of fruit and vegetables tended to be associated with a reduced risk of death from cardiovascular disease High consumption of vitamin E, either by dietary means or from supplement use, may lower the risk of liver cancer according to a new study from China.

For almost a century, the biological role of vitamin E has been a scientific puzzle. Since its discovery, vitamin E has been extensively researched by many scientists in an attempt to fully understand its role in a variety of diseases.

According to new US research, adequate lutein and zeaxanthin concentrations in the retina of the eye seem to be linked to improved reaction time and balance ability in adults. Topic of the Month Antioxidants in the Prevention of Cardiovascular Disease — Part 1: Epidemiological Studies.

Published on. The effects of free radicals Without oxygen important metabolic processes for the generation of energy cannot take place. Testing the preventive effects of antioxidants in studies Studies with experimental animals have shown that chronic diseases such as atherosclerosis and hypertension , as well as cancer and diabetes , can be brought on by oxidative stress.

Results from epidemiological studies Results from case-control and cohort studies indicate that the antioxidant vitamins C and E and also beta-carotene could have an important role to play in the primary prevention of cardiovascular disease. Vitamin E In three large-scale prospective cohort studies on men and women an association was observed between increased intake of vitamin E and a reduced risk of coronary heart disease.

Meta-analyses Results from meta-analyses of epidemiological studies into the reduction of risk of cardiovascular disease through increased intake of antioxidant micronutrients in the diet or as food supplements diverge in some cases — as do those from the studies they examine. Gale C.

et al. Vitamin C and risk of death from stroke and coronary heart disease in cohort of elderly people. Br Med J. Enstrom J. Vitamin C intake and mortality among a sample of the United States population.

Myint P. Plasma vitamin C concentrations predict risk of incident stroke over 10 y in 20 participants of the European Prospective Investigation into Cancer Norfolk prospective population study.

Am J Clin Nutr. Simon J. Serum ascorbic acid and cardiovascular disease prevalence in US adults. Rimm E. Vitamin E consumption and the risk of coronary heart disease in men. N Engl J Med. Stampfer M. Vitamin E consumption and the risk of coronary disease in women.

Kushi L. Dietary antioxidant vitamins and death from coronary heart disease in postmenopausal women.

In another study, a single high-fat meal i. The Chinese Cancer Prevention Trial 23 randomized patients to receive either β-carotene 15 mg per day , vitamin E 30 mg per day and selenium 15 μg per day , or placebo.

This study found that supplementation resulted in a 9 percent reduction in total mortality and a 21 percent decrease in deaths from gastric cancer.

The Alpha-Tocopherol Beta-Carotene Cancer Prevention Study 24 measured the effects of vitamin E 50 IU per day and β-carotene 20 mg per day supplementation on lung cancer and CHD. The incidence of nonfatal myocardial infarction was lower in all groups receiving supplementation and was significantly lower 32 percent in the group that received vitamin E.

Supplementation with vitamin E was associated with a nonsignificant increase in cerebral hemorrhage. Supplementation with β-carotene was associated with increased mortality rates for CHD 11 percent and lung cancer 18 percent , as well as an increase in overall mortality 8 percent.

The incidence of fatal CHD was significantly higher in the group that received β-carotene alone 75 percent and in the group receiving both vitamins 58 percent.

Vitamin E supplementation is supported by several studies Tables 2 17 — 21 and 3 22 — Increased vitamin E levels are associated with decreased CHD mortality and inversely correlated with risk of angina. Vitamin E significantly reduced the incidence of overall fatal and nonfatal CHD events by 47 percent and the incidence of nonfatal myocardial infarction by 77 percent; however, supplementation did not have a significant effect on overall mortality relative risk: 1.

Event reduction was better with supplementation at IU per day, but the study was not powered to assess dose-response significance. This clinical trial strongly supports evidence that vitamin E in dosages greater than IU per day reduces CHD events.

Vitamin C significantly improves arterial vasoreactivity and vitamin E regeneration. The National Health and Nutrition Examination Survey-I cohort study 29 found an inverse relationship between the highest vitamin C intake diet and supplements and CHD risk over 10 years in 11, U.

men and women 25 to 74 years of age. The only large primary prevention trial has been a study of 29, poorly nourished residents of Linixian, China.

The patients who received vitamin C in a dosage of mg per day and molybdenum in a dosage of 30 μg per day demonstrated no significant reduction in total or cerebrovascular mortality.

Many studies have demonstrated the ability of vitamin C to improve arterial vasoreactivity. A single dose 2 g of vitamin C has been found to improve vasoreactivity in chronic smokers, 8 patients with hypercholesterolemia 10 and patients with CHD. Research supports the benefit of a carotenoid-rich diet, but not β-carotene supplementation.

The Beta-Carotene and Retinol Efficacy Trial 27 combined β-carotene and retinol supplementation in 18, smokers and patients with asbestos exposure.

However, the study was terminated prematurely because of a significant increase in lung cancer mortality and a non-significant increase in CHD mortality.

In 12 years of β-carotene supplementation in 22, male physicians, no significant beneficial effects on CHD mortality, nonfatal MI or stroke were found. A non-significant 20 to 30 percent reduction in CHD events occurred in the physicians who had clinical evidence of atherosclerosis.

Vitamins C, E and β-carotene have few side effects. No significant toxicity has been noted for vitamin E in dosages of to 3, IU per day.

Therefore, caution is recommended when vitamin E supplementation is used in patients receiving anticoagulant therapy. In vitamin E clinical trials, no significant differences in bleeding rates were noted in supplemented and unsupplemented subjects.

Vitamin C supplementation is usually non-toxic, although diarrhea, bloating and false-negative occult blood tests can occur at dosages greater than 2 g per day. The intestinal absorptive capacity for vitamin C is approximately 3 g per day.

However, confusion arises about excess vitamin C intake causing increased oxalic acid excretion and, thus, a possibly increased risk of oxalate kidney stones as urinary vitamin C is converted to oxalate with air exposure.

Given in dosages of 30 to mg per day, β-carotene has minimal side effects. Other antioxidants that may provide protection against CHD include selenium, bioflavonoids and ubiquinone. One study 33 found that selenium levels are inversely associated with CHD mortality.

One review 7 noted that conflicting results were reported in other studies. Flavonoids are antioxidants found in tea, wine, fruits and vegetables. These antioxidants reduce platelet activation, but studies do not yet support an associated reduction in CHD.

Ubiquinone, a reduced form of coenzyme Q 10 , decreases LDL oxidation, but no eventreduction data are available. The results of studies of garlic supplements have been conflicting regarding lipoprotein and platelet effects. The B-complex vitamins, especially folate, pyridoxine vitamin B 6 and cyanocobalamin vitamin B 12 , may reduce CHD risk through a lowering of homocysteine levels.

Folic acid supplementation in a dosage greater than μg per day reduces the plasma homocysteine level. Use of a daily multivitamin supplement containing folate μg would reduce plasma homocysteine levels in most persons. Oxidized LDL is atherogenic, and specific antioxidants can inhibit LDL oxidation.

Epidemiologic studies report inverse relationships between CHD and supplementation with vitamins E, C and β-carotene. Clinical trials to reduce CHD events currently support vitamin E supplementation in dosages greater than IU per day. Vitamin C promotes vitamin E regeneration and significantly improves vasoreactivity, but clinical event reduction has not been established.

The results of β-carotene studies have generally been unfavorable, primarily for smokers. Folate reduces serum homocysteine levels, but trials focusing on CHD events have not been completed.

Ubiquinone, flavonoids, garlic and other supplements have not been adequately tested for CHD event reduction, appropriate dosing, reliability or long-term safety.

Because of the benefits from dietary antioxidants and other micronutrients, physicians should recommend consumption of a diet containing five to seven servings of fruits and vegetables per day Table 4. Based on current evidence, patients with CHD should probably take vitamin E in a dosage of IU per day; vitamin C supplementation in a dosage of to 1, mg per day should also be considered in these patients.

Patients receiving warfarin Coumadin therapy should limit vitamin E intake to IU per day and should avoid vitamin E if they are at high risk for bleeding. Cohort studies suggest that patients with conditions in which LDL oxidation is common i. Supplementation of β-carotene is not recommended for CHD prevention because of the possible harm demonstrated in several studies.

A high-quality diet or a daily multivitamin may be a useful way to obtain important B vitamins, especially folate μg per day , which lowers homocysteine levels. Diaz MN, Frei B, Vita JA, Keaney JF. Antioxidants and atherosclerotic heart disease.

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Antioxidant vitamin C improves endothelial dysfunction in chronic smokers. Reilly M, Delanty N, Lawson JA, FitzGerald GA. Modulation of oxidant stress in vivo in chronic cigarette smokers.

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Gaziano JM, Hatta A, Flynn M, Johnson EJ, Krinsky NI, Ridker PM, et al. Supplementation with beta-carotene in vivo and in vitro does not inhibit low-density lipoprotein oxidation. Gey KF, Puska P, Jordan P, Moser UK. Inverse correlation between plasma vitamin E and mortality from ischemic heart disease in cross-cultural epidemiology.

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Risk of angina pectoris and plasma concentrations of vitamins A, C, and E and carotene. Luoma PV, Nayha S, Sikkila K, Hassi J.

High serum alphatocopherol, albumin, selenium and cholesterol, and low mortality from coronary heart disease in northern Finland. J Intern Med. Bolton-Smith C, Woodward M, Tunstall-Pedoe H.

Dietary intake by food frequency questionnaire and odds ratios for coronary heart disease risk. The antioxidant vitamins and fibre. Eur J Clin Nutr. Knekt P, Reunanen A, Jarvinen R, Seppanen R, Heliovaara M, Aromaa A. Antioxidant vitamin intake and coronary mortality in a longitudinal population study.

Am J Epidemiol. Stampfer MJ, Hennekens CH, Manson JE, Colditz GA, Rosner B, Willett WC. Vitamin E consumption and the risk of coronary disease in women.

Rimm EB, Stampfer MJ, Ascherio A, Giovannucci E, Colditz GA, Willett WC. Vitamin E consumption and the risk of coronary heart disease in men. Losonczy KG, Harris TB, Havlik RJ. Vitamin E and vitamin C supplement use and risk of all-cause and coronary heart disease mortality in older persons: the Established Populations for Epidemiologic Studies of the Elderly.

Hodis HN, Mack WJ, LaBree L, Cashin-Hemphill L, Sevanian A, Johnson R, et al. Serial coronary angiographic evidence that antioxidant vitamin intake reduces progression of coronary artery atherosclerosis. Blot WJ, Li JY, Taylor PR, Guo W, Dawsey S, Wang GQ, et al.

J Natl Cancer Inst. Virtamo J, Rapola JM, Ripatti S, Heinonen OP, Taylor PR, Albanes D, et al. Effect of vitamin E and beta carotene on the incidence of primary nonfatal myocardial infarction and fatal coronary heart disease.

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Advanced Search. Search Menu. Article Navigation. Close mobile search navigation Article Navigation. Volume Article Contents Introduction. Free radicals and antioxidants. A protective role for antioxidants in CAD. Antioxidant activity of red wine. Antioxidant activity of a pharmaceutical preparation: a preliminary study.

Journal Article. Antioxidant therapy for the prevention of cardiovascular disease. Nuttall , S. From the Clinical Pharmacology Section, Department of Medicine, University of Birmingham, Birmingham, UK.

Nuttall, Department of Medicine, University of Birmingham, Edgbaston, Birmingham B15 2TH. Oxford Academic. Google Scholar. PDF Split View Views. Cite Cite S. Select Format Select format. ris Mendeley, Papers, Zotero.

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Introduction Coronary artery disease CAD is the major cause of death in developed countries. Free radicals and antioxidants Oxidative damage Antioxidant therapy may inhibit atherosclerosis and thereby prevent the clinical complications of the disease such as CAD, and in particular, MI. Oxidative damage in cardiovascular disease The oxidative modification of circulating lipoproteins by free radicals, particularly low-density lipoproteins LDL , is important for the development of atherosclerosis.

A protective role for antioxidants in CAD Several large-scale epidemiological studies have observed that an increase in antioxidant level limits the clinical expression of CAD. Antioxidant activity of a pharmaceutical preparation: a preliminary study One such commercially available pharmaceutical preparation Seresis Pharmaton, Conclusions The potential role of antioxidants in the prevention and treatment of disease, particularly coronary artery, cerebrovascular and peripheral vascular disease, needs to be determined.

Figure 1. Open in new tab Download slide. Figure 2. The oxidation of low-density lipoprotein LDL. Figure 3. Figure 4. Br Med J. Ann Intern Med.

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