A large epidemiological study on the interaction between inflammation, infection and antioxidants in the development of atherosclerosis

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To obtain epidemiological evidence for prevention of cardiovascular disease, we investigated the contribution of inflammation, infection and antioxidants and their interaction in the development of atherosclerosis, coronary heart disease and stroke. The subjects were approximately 100,000 Japanese men and women aged 40-79. A prospective nested case-control study was conducted to examine the associations of C-reactive protein, antibody titers of Chlamydia pneumoniae and Helicobacter pylori and antioxidant consumption and markers as well as conventional risk factors with the risk of coronary heart disease and stroke.Consumption of fish was protective against the development of coronary heart disease among Japanese (Circulation 2006). Consumption of fruits and vegetables was also inversely associated with the incidence of and mortality from stroke and mortality from coronary heart disease. Dietary intake of folate, vitamins B6 and B12 was inversely associated with the incidence of coronary heart disease. Furthermore, physical activity, consumption of calcium, vitamins C and E, and antioxidant markers such as serum alpha-tocopherol and ferulic acid were protective factors for cardiovascular disease. We found high-sensitive C reactive protein and IgA titer of Chlamydia pneumoniae was risk factor for coronary heart disease in Japanese for the first time.There was an inverse association between serum alpha-tocopherol concentrations and mortality from total cardiovascular disease, and this association was more evident among persons with higher concentrations of high-sensitive C reactive protein or Chlamydia pneumoniae IgA titer. These interactions suggest the importance of sufficient antioxidant consumption for high risk populations with chronic inflammation or continuous infection of Chlamydia pneumoniae.