People with high cholesterol who eat more antioxidants may have a lower risk of death.Vitamin E showed the strongest protective effect among all the antioxidants studied.The study suggests that lowering chronic inflammation is important for overall health.
If you’re one of the tens of millions of Americans who have elevated or borderline-elevated cholesterol, you’ve probably heard about it from your doctor. And for good reason: Cholesterol is a really important health metric to watch because it’s a major risk factor for cardiovascular disease, type 2 diabetes and stroke. While medications can help control cholesterol levels, the foods you eat are an essential part of the equation too.
One promising area of nutrition research focuses on antioxidants, which are compounds that help protect your cells from damage caused by oxidative stress. You can think of oxidative stress as your body being overwhelmed by troublemaking molecules at the cellular level. This ongoing stress plays a role in developing conditions including obesity, insulin resistance, chronic inflammation and high cholesterol.
Scientists have developed a tool called the Composite Dietary Antioxidant Index (CDAI) to measure overall antioxidant intake from foods. The CDAI evaluates six key nutrients: zinc, selenium, total carotenoids and vitamins A, C and E. Previous studies have linked higher CDAI scores to reduced risks of high blood pressure, heart failure and depression. However, little research has examined how CDAI specifically relates to mortality outcomes in people with high cholesterol.
To fill this research gap, scientists analyzed data from over 25,000 adults with high cholesterol who participated in the National Health and Nutrition Examination Survey (NHANES) between 2001 and 2018. Their findings were published in Scientific Reports.
How Was This Study Conducted?
This observational study included 25,383 American adults aged 18 and older who had been diagnosed with high cholesterol. Participants were identified through laboratory tests, self-reported diagnosis or use of cholesterol-lowering medications.
Researchers calculated each participant’s Composite Dietary Antioxidant Index score based on their intake of six antioxidants from food only—supplements were not included. Dietary information came from two 24-hour dietary recall interviews: one conducted in person and a second by telephone 3 to 10 days later. The researchers then divided participants into four groups based on their CDAI scores, from lowest to highest antioxidant intake.
The study followed participants for a median of 111 months (over nine years), tracking deaths from all causes, cardiovascular disease and cancer. The researchers adjusted their analyses for numerous factors that could influence results, including age, sex, race, education level, income, smoking and drinking habits, body mass index, other health conditions and overall diet quality.
What Did the Study Find?
During the follow-up period, there were 3,810 deaths from all causes, 1,218 deaths from cardiovascular disease and 883 deaths from cancer. The results showed a clear pattern: people with the highest Composite Dietary Antioxidant Index scores had significantly better survival rates than those with the lowest scores.
Specifically, participants in the highest antioxidant intake group had a 21% lower risk of death from any cause, a 27% lower risk of death from cardiovascular disease and a 28% lower risk of death from cancer compared to those in the lowest intake group.
When researchers examined individual antioxidants, vitamin E stood out as particularly protective. Higher vitamin E intake was associated with reduced risks across all mortality outcomes studied. The other antioxidants showed weaker or inconsistent associations.
The researchers also investigated whether inflammation might explain how antioxidants reduce mortality risk. The data showed that people eating more antioxidants had lower levels of inflammatory markers in their blood. This suggests that antioxidants may help reduce mortality risk in part by fighting inflammation, though inflammation accounted for only a modest piece of the puzzle (about 1% to 4% of the association).
Some study limitations should be noted. Since this was an observational study, it can’t prove that eating more antioxidants directly causes lower mortality—only that the two are associated. Additionally, dietary information was self-reported and based on two days of recall, which may not perfectly represent usual eating habits. The study also only included antioxidants from food, not supplements, so total antioxidant intake may have been underestimated.
How Does This Apply to Real Life?
These findings suggest that increasing your intake of antioxidant-rich foods may be an important strategy for managing high cholesterol and reducing long-term health risks. The good news is that many delicious, everyday foods are excellent sources of these protective nutrients.
For vitamin E, which showed the strongest benefits in this study, consider adding more nuts (especially almonds and hazelnuts), seeds (like sunflower seeds), spinach, broccoli, kiwi and mango to your meals. Vitamin E is a fat-soluble nutrient, meaning it’s absorbed best when eaten with some healthy fat, so drizzle olive oil on your spinach salad.
To boost your overall antioxidant intake, focus on eating a colorful variety of fruits and vegetables. Here are some tasty sources for each key nutrient:
Carotenoids: Carrots, sweet potatoes, bell peppers, tomatoes and winter squash get their vibrant orange, red and yellow hues from these antioxidants. Vitamin C: Try citrus fruits, strawberries, bell peppers, broccoli and Brussels sprouts.Vitamin A: Orange and dark green vegetables like sweet potatoes, carrots, spinach and kale are helpful sources.Zinc: Look to oysters, beef, beans, nuts and whole grains.Selenium: Brazil nuts are a great source, as are seafood, meat and whole grains.
Rather than focusing on individual nutrients, eat a varied diet rich in whole plant foods. An eating pattern that includes plenty of vegetables, fruits, nuts, seeds, whole grains and legumes will naturally provide a wide range of antioxidants and other beneficial compounds that work together to support your health.
Our Expert Take
A new study published in Scientific Reports suggests that higher intake of dietary antioxidants, particularly vitamin E, is associated with significantly reduced risks of death from all causes, cardiovascular disease and cancer among people with high cholesterol. Inflammation appears to partially explain this relationship, though its role is modest.
These findings highlight the potential importance of antioxidant-rich foods as part of a comprehensive approach to managing high cholesterol. If you have high cholesterol, consider working with a registered dietitian who can help you develop an eating plan that’s rich in antioxidants while meeting your individual nutritional needs and health goals.
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