Antioxidants and myocardial infarction : the EURAMIC study

This thesis reports the background, design and results of a multi-centre study on the relationship between diet-derived antioxidants and the risk of acute myocardial infarction (MI) in men. Levels of α-tocopherol and β-carotene in adipose tissue and of selenium in toenails were compared between almost 700 patients with first MI and a similar number of control subjects, recruited in 8 European countries and Israel. The concentration of β-carotene in adipose tissue, expressed in quintiles of the distribution in controls, was inversely associated with the risk of MI (p for trend 0.001), independently of other risk factors. This association was strongest in current cigarette smokers and in subjects with a high proportion of polyunsaturated fatty acids in the adipose tissue. The risk of MI was not related to α-tocopherol in adipose tissue. In persons with low vitamin E levels, low toenail selenium was associated with a 2.5-fold increased risk of MI, compared to high selenium levels. An additional study among 85 healthy, non-smoking volunteers, aged 50-70, showed only a modest correlation of adipose tissue concentrations with dietary intake of α-tocopherol and β-carotene assessed by a food frequency questionnaire.

Randomized controlled trials with varying doses and combinations of antioxidant nutrients should clarify whether the observed associations are causal. Until then, supplement use is not recommended, but a generous consumption of fruits and vegetables may be encouraged.