Total Antioxidant Capacity of Diet and Risk of Heart Failure: A Population-Based Prospective Cohort of Women

Study Questions:

Do dietary antioxidants reduce risk of heart failure?


Data for the present study were collected as part of the Swedish Mammography Cohort, which included 33,713 women (ages 49-83 years) born between 1914 and 1948, who lived in central Sweden. In 1997, an expanded questionnaire included questions not only on diet, but also on vitamin supplement use; cigarette smoking; alcohol consumption; physical activity; weight; height; diagnosis of hypertension, hypercholesterolemia, or diabetes (complemented with information from diabetes registers); and family history of myocardial infarction. This questionnaire served as the baseline for the present study. Estimates of dietary total antioxidant capacity were based on the Oxygen Radical Absorbance Capacity assay measurements of foods. Women were followed for incident heart failure (hospitalization or mortality of heart failure as the primary cause) through December 2009, using administrative health registries.


During 11.3 years of follow-up (394,059 person-years), 894 incident cases of heart failure were identified, including 769 hospitalizations and 125 deaths. Women with higher total antioxidant capacity of diet were more likely to have completed more than 12 years of education, less likely to be current cigarette smokers, and more likely to use dietary supplements. As expected, women with higher total antioxidant capacity of diet consumed more foods high in antioxidants. The major contributors to total antioxidant capacity of diet were fruit and vegetables, which contributed 44% of total antioxidant capacity. Other contributors were whole grains (18%), coffee (14%), and chocolate (4%). Total antioxidant capacity of diet was inversely associated with heart failure (the multivariable adjusted relative risk in the highest quintile compared with the lowest was 0.58 [95% confidence interval, 0.47-0.72; p for trend < 0.001]). The crude incidence rate was 18/10,000 person-years in the highest quintile versus 34/10,000 person-years in the lowest quintile.


The investigators concluded that the total antioxidant capacity of diet, an estimate reflecting all antioxidants in diet, was associated with lower risk of heart failure.


These data suggest that antioxidants consumed through fruits, vegetables, and whole grains may lower the risk for heart failure among women.

Clinical Topics: Dyslipidemia, Prevention, Homozygous Familial Hypercholesterolemia, Nonstatins, Diet, Hypertension, Smoking

Keywords: Risk, Myocardial Infarction, Mammography, Follow-Up Studies, Hypercholesterolemia, Smoking, Vitamins, Heart Diseases, Incidence, Fruit, Sweden, Dietary Supplements, Vegetables, Motor Activity, Cereals, Food, Diet, Oxygen, Cacao, Hypertension, Diabetes Mellitus, Coffee

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