Multivitamin use associated with lower heart attack risk in women
An article published online on September 22, 2010 in the American Journal of Clinical Nutrition reports an association between multivitamin use and a reduced risk of myocardial infarction (MI or heart attack) in older women.
The current study included 2,262 women with a history of cardiovascular disease and 31,671 women with no history of the disease who participated in the Swedish Mammography Cohort established between 1987 and 1990. The participants completed a dietary questionnaire in 1997 which provided the Karolinska Institutet researchers with information concerning supplement use.
Over the 10.2 year average follow-up period, 269 heart attacks occurred among women who had cardiovascular disease, and 932 occurred in those with no history. Among women who had no history of the disease, those who reported using a multinutrient supplement had a 27 percent lower adjusted risk of heart attack than those who were not supplement users. Using a multivitamin along with other supplements was associated with a 30 percent lower risk, and use for at least five years was linked to a 41 percent lower risk of myocardial infarction compared to nonusers. Multivitamin use was not associated with a significant benefit in those with pre-existing disease.
Concerning the contradiction of the current study's findings with other research which failed to uncover a benefit, the authors explain that ingredients and dosage of the components of multinutrient supplements vary, that some trials were conducted in subjects with pre-existing cardiovascular disease, and that the majority of trials had short follow-up periods. They attribute the vitamins' protective benefit to their antioxidant properties, which retard atherosclerosis via free radical scavenging, and the ability of B vitamins to lower homocysteine levels. Minerals included in multinutrient supplements may also have cardioprotective effects, including the possibility of magnesium to inhibit insulin resistance, decrease vascular tone, and prevent pro-inflammatory changes and endothelial dysfunction, and the incorporation of selenium into protective antioxidant enzymes.
"We observed that multivitamin use is inversely associated with myocardial infarction among women with no history of cardiovascular disease," the authors conclude. "Further studies are needed to confirm or refute our findings and, if confirmed, to clarify what composition of multivitamins (doses and ingredients included) and duration of use is needed to observe beneficial effects on MI."
Only about half the people with coronary artery disease have more traditional risk factors, such as elevated cholesterol, smoking, high blood pressure, and obesity. Yet all patients with atherosclerosis suffer from endothelial dysfunction and the damaging effects of oxidized LDL, which provides an important building block for plaque deposits. Antioxidant therapy is therefore important to limit the oxidization of LDL and improve the health of the endothelium by limiting the damage caused by inflammatory cytokines. The following antioxidants are some of the most effective studied in atherosclerosis:
Vitamin C inhibits damage caused by oxidative stress. In cigarette smokers, daily supplementation with 500 mg vitamin C significantly decreased the appearance of oxidative stress markers (Dietrich M et al 2002). Another study showed that supplementation with 500 mg vitamin C and 400 IU vitamin E daily significantly reduced the development of accelerated coronary arteriosclerosis following cardiac transplantation (Fang JC et al 2002). Vitamin C’s benefits seem especially profound in people who suffer from both diabetes and coronary artery disease. One study demonstrated that, in this group, vitamin C significantly improved vasodilation (Antoniades C et al 2004).
Vitamin K is steadily gaining attention for its ability to reduce calcification and help prevent cardiovascular disease (Jie KSG et al 1996). Evidence for the ability of vitamin K to prevent calcification can also be found in an animal study in which researchers administered the anticoagulant warfarin to rats. Warfarin is known to deplete vitamin K. At the end of the study, all the animals had extensive calcification, suggesting they had lost the protective effect of vitamin K (Howe AM 2000).
Vitamin E is often studied in conjunction with vitamin C for its potent antioxidant powers. It has been shown to decrease lipid peroxidation and inhibit smooth muscle cell proliferation, platelet aggregation, monocyte adhesion, oxidized LDL uptake, and cytokine production—all of which occur during atherosclerosis (Munteanu A et al 2004; Harris A et al 2002). In cultured arterial endothelial cells, vitamin E increased the production of prostacyclin, a potent vasodilator and inhibitor of platelet aggregation (Wu D et al 2004). Most vitamin E supplements come in the form of alpha-tocopherol. Life Extension recommends about 400 IU alpha-tocopherol a day, along with at least 200 mg gamma tocopherol and 100 mg of coenzyme Q10. There is a concern that taking only the “alpha” form of vitamin E could deplete the body of gamma tocopherol, a critically important antioxidant.
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