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

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

Jian Li #  1 , Changqing Li  2 , Lin Tao  3 , Lei Wang  3 , Gang Wang  4 , Youqi Kong  2 , Lichun Zhou #  5
Affiliations

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

Jian Li et al. BMC Cardiovasc Disord. .

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.

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Conflict of interest statement

Declarations. Ethical approval and informed consent: The NHANES data collection for 2017–2018 was approved by the National Center for Health Statistics (NCHS) Research Ethics Review Board (Protocol #2018-01). This study utilized publicly available, de-identified data, which exempt it from additional institutional review board approval. As per national guidelines, written informed consent was obtained from all participants during the original NHANES data collection process. Clinical trial number: Not applicable. Publisher’s note: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher. Competing interests: The authors declare no competing interests. Conflict of interest: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Fig. 1
Fig. 1
Flowchart of participant selection. NHANES, National Health and Nutrition Examination Survey
Fig. 2
Fig. 2
This curve fitting plot depicts the association between serum vitamin E concentration and the incidence of CVDs. The analysis was adjusted for multiple confounders, including age, sex, race/ethnicity, education level, family poverty-income ratio, smoking status, alcohol consumption, history of diabetes, TC, TG, uric acid, and serum creatinine. The solid line represents the fitted curve estimating the association, while the dashed lines correspond to the 95% confidence intervals (CIs)
See this image and copyright information in PMC

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