An Investigation of the Relationship between Serum Vitamin E Status and Coronary Risk Factors in Dyslipidaemic Patients

Document Type: Original Article

Authors

1 Cardiovascular Research Center, Avicenna Research Institute, Mashhad University of Medical Sciences (MUMS), Mashhad, Iran

2 Department of Nutrition and Biochemistry, Faculty of Medicine, MUMS, Mashhad, Iran.

3 School of Pharmacy, MUMS, Mashad, Iran, Postal Code: 91775-1365

4 Centre for Clinical Science & Measurement, University of Surrey, Stag Hill, Guildford, Surrey, GU2 7XH, United Kingdom

Abstract

Objective
Vitamin E is a major lipid-soluble antioxidant. It has been demonstrated that vitamin E supplementation has a beneficial effect against coronary heart disease (CHD). This study to investigate the effects of coronary risk factors on serum vitamin E status in patients with dyslipidaemia.
Materials and Methods
This tertiary care hospital; case - control study was comprised 237 dyslipidaemic patients and 135 healthy individuals recruited from university and hospital employees. Serum vitamin E concentration was measured using high performance liquid chromatography (HPLC).
Results
Compared to the healthy individuals, the dyslipidaemic patients had higher serum vitamin E (p<0.001), but serum vitamin E / total cholesterol ratio did not differ between patients and healthy controls (p>0.05). Serum vitamin E did not differ between subcategories of dyslipidaemic patients with and without coronary risk factors (p>0.05), but Serum vitamin E / total cholesterol ratio was higher in patients with established coronary heart disease (p<0.01), hypertriglyceridaemia (p<0.05) and metabolic syndrome (p<0.05). In the patients there was not a strong association between serum vitamin E or serum vitamin E / total cholesterol ratio and coronary risk factors except for the serum cholesterol.
Conclusion
Serum vitamin E or vitamin E / total cholesterol ratio is not associated with the risk of coronary heart disease. Therefore, higher serum vitamin E or vitamin E / total cholesterol ratio doesn’t seem to have a preventive role against coronary heart disease.

Keywords


1.     Princen HM, van Poppel G, Vogelezang C, Buytenhek R, Kok FJ. Supplementation with vitamin E but not beta-carotene in vivo protects low density lipoprotein from lipid peroxidation in vitro. Effect of cigarette smoking. Arterioscler Thromb 1992; 12:554-62.

2. Reaven PD, Khouw A, Beltz WF, Parthasarathy S, Witztum JL. Effect of dietary antioxidant combinations in humans. Protection of LDL by vitamin E but not by beta-carotene. Arterioscler Thromb 1993; 13:590-600.

3. Hodis HN, Mack WJ, LaBree L, Mahrer PR, Sevanian A, Liu CR, et al. Alpha-tocopherol supplementation in healthy individuals reduces low-density lipoprotein oxidation but not atherosclerosis: the Vitamin E Atherosclerosis Prevention Study (VEAPS). Circulation 2002; 106:1453-9.

4. Freedman JE, Farhat JH, Loscalzo J, Keaney JF, Jr. alpha-tocopherol inhibits aggregation of human platelets by a protein kinase C-dependent mechanism. Circulation 1996; 94:2434-40.

5. Vogel RA, Corretti MC, Plotnick GD. Effect of a single high-fat meal on endothelial function in healthy subjects. Am J Cardiol 1997; 79:350-4.

6. Smith TL, Kummerow FA. Effect of dietary vitamin E on plasma lipids and atherogenesis in restricted ovulator chickens. Atherosclerosis 1989; 75:105-9.

7. Verlangieri AJ, Bush MJ. Effects of d-alpha-tocopherol supplementation on experimentally induced primate atherosclerosis. J Am Coll Nutr 1992; 11:131-8.

8. Meydani M. Vitamin E modulation of cardiovascular disease. Ann N Y Acad Sci 2004; 1031:271-9.

9. Salonen RM, Nyyssonen K, Kaikkonen J, Porkkala-Sarataho E, Voutilainen S, Rissanen TH, et al. Six-year effect of combined vitamin C and E supplementation on atherosclerotic progression: the Antioxidant Supplementation in Atherosclerosis Prevention (ASAP) Study. Circulation 2003; 107:947-53.

10.  Heinecke JW. Clinical trials of vitamin E in coronary artery disease: is it time to reconsider the low-density lipoprotein oxidation hypothesis? Curr Atheroscler Rep 2003; 5:83-7.

11.  Jialal I, Grundy SM. Effect of dietary supplementation with alpha-tocopherol on the oxidative modification of low density lipoprotein. J Lipid Res 1992; 33:899-906.

12.  Engelen W, Keenoy BM, Vertommen J, De Leeuw I. Effects of long-term supplementation with moderate pharmacologic doses of vitamin E are saturable and reversible in patients with type 1 diabetes. Am J Clin Nutr 2000; 72:1142-9.

13.  Meyer F, Bairati I, Dagenais GR. Lower ischemic heart disease incidence and mortality among vitamin supplement users. Can J Cardiol 1996; 12:930-4.

14.  Stampfer MJ, Hennekens CH, Manson JE, Colditz GA, Rosner B, Willett WC. Vitamin E consumption and the risk of coronary disease in women. N Engl J Med 1993; 328:1444-9.

15.  Boaz M, Smetana S, Weinstein T, Matas Z, Gafter U, Iaina A, et al. Secondary prevention with antioxidants of cardiovascular disease in endstage renal disease (SPACE): randomised placebo-controlled trial. Lancet 2000; 356:1213-8.

16.  Marchioli R. [Results of GISSI Prevenzione: diet, drugs, and cardiovascular risk. Researchers of GISSI Prevenzione]. Cardiologia 1999; 44 Suppl 1:745-6.

17.  McQueen MJ, Lonn E, Gerstein HC, Bosch J, Yusuf S. The HOPE (Heart Outcomes Prevention Evaluation) Study and its consequences. Scand J Clin Lab Invest Suppl 2005; 240:143-56.

18.  Yusuf S, Sleight P, Pogue J, Bosch J, Davies R, Dagenais G. Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. The Heart Outcomes Prevention Evaluation Study Investigators. N Engl J Med 2000;42:145-53.

19.  Yusuf S. From the HOPE to the ONTARGET and the TRANSCEND studies: challenges in improving prognosis. Am J Cardiol 2002; 89:18A-25A; discussion 25A-26A.

20.  Pryor WA. Vitamin E and heart disease: basic science to clinical intervention trials. Free Radic Biol Med 2000; 28:141-64.

21.  Dietary supplementation with n-3 polyunsaturated fatty acids and vitamin E after myocardial infarction: results of the GISSI-Prevenzione trial. Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto miocardico. Lancet 1999; 354:447-55.

22.  Rapola JM, Virtamo J, Haukka JK, Heinonen OP, Albanes D, Taylor PR, et al. Effect of vitamin E and beta carotene on the incidence of angina pectoris. A randomized, double-blind, controlled trial. JAMA 1996; 275:693-8.

23.  Stephens NG, Parsons A, Schofield PM, Kelly F, Cheeseman K, Mitchinson MJ. Randomised controlled trial of vitamin E in patients with coronary disease: Cambridge Heart Antioxidant Study (CHAOS). Lancet 1996; 347:781-6.

24.  Yusuf S, Dagenais G, Pogue J, Bosch J, Sleight P. Vitamin E supplementation and cardiovascular events in high-risk patients. The Heart Outcomes Prevention Evaluation Study Investigators. N Engl J Med 2000; 342:154-60.

25.  Eidelman RS, Hollar D, Hebert PR, Lamas GA, Hennekens CH. Randomized trials of vitamin E in the treatment and prevention of cardiovascular disease. Arch Intern Med 2004; 164:1552-6.

26.  Moens AL, Claeys MJ, Timmermans JP, Vrints CJ. Myocardial ischemia/reperfusion-injury, a clinical view on a complex pathophysiological process. Int J Cardiol 2005; 100:179-90.

27.  Shekelle PG, Morton SC, Jungvig LK, Udani J, Spar M, Tu W, et al. Effect of supplemental vitamin E for the prevention and treatment of cardiovascular disease. J Gen Intern Med 2004; 19:380-9.

28.  James WPT, Schofield EC. Human Energy Requirements: A Manual for Planners and Nutritionists. New York: Oxford University Press; 1990.

29.  Friedewald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem 1972; 18:499-502.

30.  Ferns G, Williams J, Forster L, Tull S, Starkey B, Gershlick A. Cholesterol standardized plasma vitamin E levels are reduced in patients with severe angina pectoris. Int J Exp Pathol 2000; 81:57-62.

31.  Winklhofer-Roob BM, Rock E, Ribalta J, Shmerling DH, Roob JM. Effects of vitamin E and carotenoid status on oxidative stress in health and disease. Evidence obtained from human intervention studies. Mol Aspects Med 2003; 24:391-402.

32.  Sobczak A, Golka D, Szoltysek-Boldys I. The effects of tobacco smoke on plasma alpha- and gamma-tocopherol levels in passive and active cigarette smokers. Toxicol Lett 2004; 151:429-37.

33.  Salonen JT, Salonen R, Penttila I, Herranen J, Jauhiainen M, Kantola M, et al. Serum fatty acids, apolipoproteins, selenium and vitamin antioxidants and the risk of death from coronary artery disease. Am J Cardiol 1985; 56:226-31.

34.  Kok FJ, de Bruijn AM, Vermeeren R, Hofman A, van Laar A, de Bruin M, et al. Serum selenium, vitamin antioxidants, and cardiovascular mortality: a 9-year follow-up study in the Netherlands. Am J Clin Nutr 1987; 45:462-8.

35.  Evans RW, Shaten BJ, Day BW, Kuller LH. Prospective association between lipid soluble antioxidants and coronary heart disease in men. The Multiple Risk Factor Intervention Trial. Am J Epidemiol 1998; 147:180-6.

36.  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 1994; 139:1180-9.

37.  Kushi LH, Fee RM, Sellers TA, Zheng W, Folsom AR. Intake of vitamins A, C, and E and postmenopausal breast cancer. The Iowa Women's Health Study. Am J Epidemiol 1996; 144:165-74.

38.  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. Am J Clin Nutr 1996; 64:190-6.

39.  Assmann G, Cullen P, Schulte H. Simple scoring scheme for calculating the risk of acute coronary events based on the 10-year follow-up of the prospective cardiovascular Munster (PROCAM) study. Circulation 2002; 105:310-5.

40.  Ford ES, Giles WH, Dietz WH. Prevalence of the metabolic syndrome among US adults: findings from the third National Health and Nutrition Examination Survey. JAMA 2002; 287:356-9.