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CLINICAL STUDY: RISK FACTORS

Antioxidant vitamins and the risk of carotid atherosclerosis

The perth carotid ultrasound disease assessment study (CUDAS)

Brendan M. McQuillan, MBBS, FRACP^* , Joseph Hung, MBBS, FRACP, FACC, John P. Beilby, PhD, FAACB, Mark Nidorf, MD, FRACP, FACC and Peter L. Thompson, MD, FRACP, FACC^*,

^* Gairdner Campus of the Heart Research Institute of Western Australia, Nedlands, Perth, Western Australia
Department of Cardiovascular Medicine, Sir Charles Gairdner Hospital, Nedlands, Perth, Western Australia
Department of Medicine, University of Western Australia, Nedlands, Perth, Western Australia
Clinical Biochemistry, PathCentre, QEII Medical Center, Nedlands, Perth, Western Australia

Manuscript received December 6, 2000; revised manuscript received August 30, 2001, accepted September 4, 2001.

^* Reprint requests and correspondence: Prof. Peter L. Thompson, Department of Cardiovascular Medicine, Sir Charles Gairdner Hospital, Verdun Street, Nedlands, WA 6009, Australia
peter.thompson{at}health.wa.gov.au

OBJECTIVES

This study examined whether dietary intake or plasma levels of antioxidant vitamins were independently associated with common carotid artery intima-media (wall) thickness (IMT) or focal plaque, or both, in a large, randomly selected community population.

BACKGROUND

Oxidation of low-density lipoprotein (LDL) cholesterol is thought to be important in early atherogenesis. Antioxidant micronutrients may therefore protect against lipid peroxidation and atherosclerotic vascular disease.

METHODS

We studied 1,111 subjects (558 men and 553 women; age 52 ± 13 years [mean ± SD], range 27 to 77). We measured dietary vitamin intake and fasting plasma levels of vitamins A, C and E, lycopene and alpha- and beta-carotene and performed bilateral carotid artery B-mode ultrasound imaging.

RESULTS

After adjustment for age and conventional risk factors, there was a progressive decrease in mean IMT, with increasing quartiles of dietary vitamin E intake in men (p = 0.02) and a nonsignificant trend in women (p = 0.10). Dietary vitamin E levels accounted for 1% of the variance in measured IMT in men. For plasma antioxidant vitamins, there was an inverse association between carotid artery mean IMT and plasma lycopene in women (p = 0.047), but not in men. None of the other dietary or plasma antioxidant vitamins, nor antioxidant vitamin supplements, were associated with carotid artery IMT or focal carotid artery plaque.

CONCLUSIONS

This study provides limited support for the hypothesis that increased dietary intake of vitamin E and increased plasma lycopene may decrease the risk of atherosclerosis. No benefit was demonstrated for supplemental antioxidant vitamin use.

Abbreviations and Acronyms   ARIC = Atherosclerosis Risk In Communities study   CI = confidence interval   CSIRO = Commonwealth Scientific and Industrial Research Organization   CUDAS = Carotid Ultrasound Disease Assessment Study   EVA = Etude sur le Viellissement Artériel   IMT = intima-media thickness   HDL = high-density lipoprotein   LDL = low-density lipoprotein   OR = odds ratio

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