Serum vitamin E and cardiovascular diseases risk: a J-shaped association in a large cross-sectional study

BMC Cardiovasc Disord. 2025 Jul 5;25(1):489. doi: 10.1186/s12872-025-04779-5.

Abstract

Objective: Cardiovascular diseases (CVDs) has been identified as a primary cause of mortality on a global scale. The present study was conducted with the objective of investigating the association between serum vitamin E levels and the risk of developing CVDs, with the aim of identifying potential risk thresholds.

Methods: Using National Health and Nutrition Examination Survey (NHANES) data from 1999 to 2002, we included 3,516 adult participants. Serum vitamin E concentrations were measured by high-performance liquid chromatography, and CVDs status was assessed through medical questionnaires and interviews. Multivariable logistic regression and segmented linear models analyzed the association between serum vitamin E and CVDs risk.

Results: A J-shaped relationship between serum vitamin E and CVDs risk was observed. Segmented linear regression revealed a nonlinear association between vitamin E concentration and CVDs incidence. At low concentrations (below 85.24 µg/dL), although the OR suggested a potential protective trend (OR: 0.968, 95% CI: 0.926-1.011), this association did not reach statistical significance (P = 0.1422), indicating no conclusive evidence of risk reduction. Beyond this threshold, CVDs risk significantly increased (OR: 1.056, 95% CI: 1.003-1.112, P = 0.0377). Notably, the high-concentration group demonstrated a substantially elevated CVDs risk, with a 4.18-fold increase (OR: 4.18, 95% CI: 2.84-6.16, P < 0.0001).

Conclusion: Maintaining serum vitamin E levels within an optimal range is crucial for reducing CVDs risk. The study reveals the complex nonlinear relationship between vitamin E concentration and disease risk, providing important insights for clinical practice and public health strategies.

Keywords: Cardiovascular diseases; Cross-sectional study; NHANES; Nonlinear relationship; Threshold effect; Vitamin E.

MeSH terms

  • Adult
  • Aged
  • Biomarkers / blood
  • Cardiovascular Diseases* / blood
  • Cardiovascular Diseases* / diagnosis
  • Cardiovascular Diseases* / epidemiology
  • Cross-Sectional Studies
  • Female
  • Heart Disease Risk Factors
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Nutrition Surveys
  • Risk Assessment
  • Risk Factors
  • United States / epidemiology
  • Vitamin E Deficiency* / blood
  • Vitamin E Deficiency* / diagnosis
  • Vitamin E Deficiency* / epidemiology
  • Vitamin E* / blood

Substances

  • Vitamin E
  • Biomarkers