Vitamine-E and coronory heart-disease: the European paradox

Objective: To relate premature mortality from coronary heart disease (CHD) to national food and nutrient supplies.

Design: Descriptive correlational study.

Setting: Nineteen western European and five non-European countries.

Methods: Premature mortality from CHD in men below 65 years was related to recalculated Food and Agriculture Organization (FAO) food, antioxidant vitamins and other nutrient supply data in 24 developed countries for 1985-87. Longitudinal analyses of death rates from CHD and supplies between 1970 and 1987 were carried out for all the countries. Correlational analyses of supplies that preceded mortality by up to 10 years were also undertaken.

Results: In 17 western European countries the inter-country association of dairy product supply with CHD was of moderate strength (r = 0.5) and the principal saturated fatty acids derived from dairy products: butyric, caproic and myristic acids (C4:0, C6:0 and C14:0) were the most strongly related with CHD (r = 0.5, 0.5 and 0.4 respectively). The phenolic-antioxidant-rich foods, e.g. wine, vegetables and vegetable oils, were inversely related to CHD (r = -0.8, -0.7 and -0.6 respectively). Of the antioxidant vitamins, the alpha-tocopherol component of vitamin E was strongly related to CHD across Europe (r = -0.8). The major determinant of alpha-tocopherol supply was usually sunflowerseed oil. Vitamin C and beta-carotene gave moderate correlations (r = -0.6 and -0.5 respectively). Latency periods of 5 and 10 years between supplies and mortality rates did not markedly change the correlations. Longitudinal analyses of nutrient supplies and death rates within each country from 1970 to 1987 also showed that for the majority of countries there was an inverse association between supply of alpha-tocopherol and CHD.

Conclusions: Dietary alpha-tocopherol may provide at least as good an explanation as does wine for the paradoxically low rates of CHD in several European countries which have a relatively high saturated fatty acid intake.