Czernichow S, Hercberg S
U-557 INSERM (UMR INSERM / INRA / CNAM), Institut Scientifique et Technique de la Nutrition et de l'Alimentation, CNAM - 5, rue Vertbois, F-75003 Paris.
J Nutr Health Aging. 2001;5(3):188-95.
Cardiovascular diseases continue to constitute a major public health problem in all industrialized countries, where they are the main causes of premature mortality. There is a large body of evidence suggesting that free radical production directly or indirectly plays a major role in cellular processes implicated in atherosclerosis. Here we present mechanistic data and results of epidemiologic studies on the relationship between antioxidant vitamin intake or biochemical status and the risk of cardiovascular diseases. Most epidemiologic data obtained on this topic have been based on observational approaches, i.e. ecological studies, case-control or prospective studies. All these studies indicate that a high dietary intake or high blood concentrations of antioxidant vitamins are associated with a reduced risk of cardiovascular diseases. Although the results of these studies are convergent, they merely suggest a relationship at the population and individual level, but do not affirm a causality link. Only intervention studies (randomized trials), by specifically changing antioxidant vitamin intake, can provide conclusive answers. The apparent discrepancies between the results of recently published trials may be explained by the type of population (general or high-risk subjects), the differing doses of supplementation (nutritional levels or higher), the number of antioxidants tested (one, two or more) and the type of administration (alone or in balanced association). It thus appears that low risk of pathologies may be related to multiple nutrients consumed, at nutritional doses, and in combination. Optimal effects may be expected with a combination of nutrients at levels similar to those found in a healthy diet. A single antioxidant vitamin given at high doses in subjects with high risk of pathologies may not have substantial benefits and could even have negative consequences.
在所有工业化国家，心血管疾病仍然是一个重大的公共卫生问题，是过早死亡的主要原因。大量证据表明，自由基的产生直接或间接在动脉粥样硬化相关的细胞过程中起主要作用。在此，我们展示了关于抗氧化剂维生素摄入量或生化状态与心血管疾病风险之间关系的机制数据和流行病学研究结果。关于这一主题获得的大多数流行病学数据都基于观察性方法，即生态学研究、病例对照研究或前瞻性研究。所有这些研究均表明，高膳食摄入量或高血液浓度的抗氧化剂维生素与降低的心血管疾病风险相关。尽管这些研究结果是一致的，但它们仅表明了人群和个体层面的一种关系，并未确认因果联系。只有干预研究（随机试验）通过专门改变抗氧化剂维生素的摄入量才能提供确凿答案。最近发表的试验结果之间明显的差异可能由人群类型（普通或高危受试者）、补充剂量不同（营养水平或更高）、测试的抗氧化剂数量（一种、两种或更多）以及给药类型（单独或联合均衡使用）来解释。因此，似乎低发病风险可能与以营养剂量联合摄入的多种营养素有关。与健康饮食中发现的水平相似的营养素组合可能会产生最佳效果。在高发病风险的受试者中高剂量给予单一抗氧化剂维生素可能不会有实质性益处，甚至可能产生负面后果。
