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Nutritional antioxidants in coronary heart disease

Christine C Tangney, PhD
Robert S Rosenson, MD
Section Editor
Bernard J Gersh, MB, ChB, DPhil, FRCP, MACC
Deputy Editor
Daniel J Sullivan, MD, MPH


Antioxidants have been evaluated for both primary and secondary prevention of coronary heart disease (CHD). Studies of the mechanisms of atherosclerosis suggest that antioxidants might be protective. Observational studies appeared to show benefits with higher intake of some antioxidants. Additionally, cardiovascular protection has been associated with dietary patterns high in antioxidants (from fruit and vegetables) [1] and with higher circulating levels of alpha-tocopherol [2]. However, most randomized controlled trials have not found antioxidant supplementation to be effective for the prevention of CHD.

The potential efficacy of the nutritional antioxidants vitamin E, vitamin C, and beta-carotene and other carotenoids is reviewed here. Each is considered separately, as each appears to have distinct risks and benefits.

It is more difficult to assess the efficacy of dietary antioxidants in randomized trials. The association between dietary antioxidants and cardioprotection, despite the lack of benefits seen in trials of supplements, may reflect issues of confounding and bias in observational studies or may occur because the full complement of antioxidants in foods are different from what is found in supplements or are present in more optimal ratios.

The role of antioxidants in conditions other than CHD is discussed separately. (See "Vitamin supplementation in disease prevention", section on 'Antioxidant vitamins'.)

Also discussed separately are the effects of the antioxidant probucol on lipids and the effects of probucol and succinobucol on cardiovascular outcomes after percutaneous coronary intervention. (See "Low density lipoprotein cholesterol lowering with drugs other than statins and PCSK9 inhibitors", section on 'Probucol'.)

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Literature review current through: Sep 2017. | This topic last updated: May 22, 2017.
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