Heart disease and stroke are mainly consequences of atherosclerosis and high blood pressure (hypertension). Heart disease is sometimes included in the broader category of atherosclerotic and hypertensive diseases. Risk factors for heart disease and stroke have been well established for many years. Distinct from age, family history, and possible genetic determinants are modifiable risk factors that cause heart attacks and strokes, including high blood cholesterol, high blood pressure, smoking, and diabetes. Behaviors that contribute to development of risk factors for heart disease, partly by causing obesity, include adverse dietary patterns and physical inactivity.

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Social and environmental conditions that may determine such behavioral patterns, in turn, include education and income, cultural influences, family and personal habits, and opportunities to make favorable choices.For example, dietary patterns result from the influences of food production policies, marketing practices, product availability, cost, convenience, knowledge, choices that affect health, and preferences that are often based on early-life habits. Because many aspects of behavior are clearly beyond the control of the individual, the scope of heart disease and Stroke and stroke prevention, from the public health perspective, extends far beyond the individual or the patient. Thus, a comprehensive public health strategy for heart disease prevention must address the broader determinants of risk and disease burden as they affect both the population as a whole and particular groups of special concern, including those determinants that make healthier choices more likely for defeating heart disease.

Epidemiologic studies have suggested that higher intakes of fruit, vegetables, and whole grain are related to a lower risk of coronary heart disease (CHD). One explanation for this finding is a reduction in oxidatively modified LDL, which is thought to play an important role in the development of atherosclerosis. Whether the association between these foods and CHD is due to antioxidant vitamins or some other factors remains unclear.

In the present Pooling Project of Cohort Studies on Diet and Coronary Disease, the authors studied the relations of the intakes of vitamin E, five carotenoids, and vitamin C to the incidence of all major CHD events and CHD mortality by pooling primary data from nine major cohorts studies. This large database enabled several issues to be examined, such as whether 1) single antioxidants or combinations of them predict CHD occurrence, 2) the strength of associations differs by dietary and supplemental intake and 3) non-dietary or dietary risk factors of CHD modify the association.

During a 10-year follow-up, 4,647 major incident CHD events occurred in 293,172 subjects who were free of CHD at baseline. Diet was measured by using a food frequency questionnaire in seven cohorts and by using a dietary history interview or food records in two cohorts. Overall intakes (dietary and supplemental combined) of vitamin E, beta-carotene, total carotene, and vitamin C were calculated.