New Study: These Foods Could Reduce Mortality Risk by 21% for Those with High Cholesterol

Reviewed by: Dietitian Emily Lachtrupp, M.S., RD

Key Takeaways:

• Adults with elevated cholesterol who consume more antioxidants may experience a reduced risk of death.
• Vitamin E emerged as the most protective antioxidant in the study.
• Reducing chronic inflammation may play a role in overall health benefits.

Cholesterol is a critical health marker, influencing the risk of cardiovascular disease, type 2 diabetes, and stroke. While medications help manage cholesterol levels, diet remains a central factor. Recent research highlights antioxidantscompounds that shield cells from oxidative stressas potentially important in managing these risks.

Oxidative stress occurs when harmful molecules overwhelm the body at the cellular level, contributing to conditions like obesity, insulin resistance, chronic inflammation, and high cholesterol.

Measuring Antioxidant Intake

Researchers have developed the Composite Dietary Antioxidant Index (CDAI) to assess total dietary antioxidant intake from food. This index evaluates six nutrients: zinc, selenium, total carotenoids, and vitamins A, C, and E. Previous studies link higher CDAI scores to lower risks of high blood pressure, heart failure, and depression, though little was known about its impact on mortality for people with high cholesterol.

Study Overview

Data from over 25,000 adults with high cholesterol, collected through the National Health and Nutrition Examination Survey (NHANES) between 2001 and 2018, were analyzed and published in Scientific Reports.

The study included 25,383 U.S. adults aged 18+ diagnosed with high cholesterol through lab tests, self-report, or use of cholesterol-lowering medications. CDAI scores were calculated using only food-based antioxidant intake, gathered from two 24-hour dietary recall interviews. Participants were divided into four groups based on antioxidant consumption, from lowest to highest.

Researchers tracked participants for a median of 111 months (over nine years), monitoring deaths from all causes, cardiovascular disease, and cancer. Analyses were adjusted for factors such as age, sex, race, education, income, lifestyle habits, BMI, health conditions, and diet quality.

Findings

During the follow-up, 3,810 deaths from all causes, 1,218 from cardiovascular disease, and 883 from cancer were recorded. Those with the highest CDAI scores had significantly better survival rates than those with the lowest scores:

• 21% lower risk of death from any cause
• 27% lower risk of death from cardiovascular disease
• 28% lower risk of death from cancer

Vitamin E was particularly protective, showing consistent associations across all mortality outcomes. Other antioxidants had weaker or inconsistent effects.

The study also suggested that reduced inflammation might partly explain the protective effect of antioxidants. Participants with higher antioxidant intake had lower levels of inflammatory markers, although inflammation accounted for only 14% of the mortality association.

Study Limitations

• Observational design means the study cannot prove causation, only association.
• Dietary data were self-reported and based on two days of recall, which may not reflect usual intake.
• The study only considered antioxidants from foods, not supplements, possibly underestimating total intake.

Practical Takeaways

Incorporating antioxidant-rich foods can support cholesterol management and reduce long-term health risks. Key foods for vitamin E include almonds, hazelnuts, sunflower seeds, spinach, broccoli, kiwi, and mango. Since vitamin E is fat-soluble, pairing it with healthy fats, such as olive oil, improves absorption.

For a broader antioxidant boost, include a colorful variety of fruits and vegetables:

• Carotenoids: Carrots, sweet potatoes, bell peppers, tomatoes, squash
• Vitamin C: Citrus fruits, strawberries, bell peppers, broccoli, Brussels sprouts
• Vitamin A: Orange and dark green vegetables like sweet potatoes, carrots, spinach, kale
• Zinc: Oysters, beef, beans, nuts, whole grains
• Selenium: Brazil nuts, seafood, meat, whole grains

Overall, a diet rich in whole plant foodsincluding vegetables, fruits, nuts, seeds, whole grains, and legumesnaturally provides a spectrum of antioxidants that work together to support health.

Expert Insight

Higher dietary antioxidant intake, particularly vitamin E, is associated with lower risks of death from all causes, cardiovascular disease, and cancer among adults with high cholesterol. Inflammation may partially mediate this benefit, though its effect is modest. Antioxidant-rich foods should be considered as part of a comprehensive cholesterol management strategy, ideally with guidance from a registered dietitian.

Analysis: The Role of Antioxidants in Cholesterol Management and Long-Term Health

Recent research underscores the importance of antioxidants, particularly vitamin E, in managing cholesterol levels and reducing the risk of mortality among adults with high cholesterol. The study, which analyzed over 25,000 participants, indicates that higher antioxidant intake from food sources is linked to a significant reduction in death rates from cardiovascular diseases, cancer, and all causes. This finding suggests that antioxidants, through their ability to combat oxidative stress, can play a crucial role in overall health and longevity.

The study's use of the Composite Dietary Antioxidant Index (CDAI) to evaluate participants' antioxidant intake offers a clear picture of the protective benefits of a diet rich in antioxidants. While the research design cannot establish causality, the strong association between higher CDAI scores and improved survival rates highlights the potential benefits of prioritizing antioxidant-rich foods in the diet. This is especially important for individuals managing high cholesterol, a key risk factor for cardiovascular diseases.

Vitamin E emerged as the most protective antioxidant, with its intake consistently correlating with lower mortality rates. This reinforces the value of incorporating foods high in vitamin E, such as almonds, hazelnuts, and spinach, into daily meals. Additionally, the study points to a broader benefit of antioxidant-rich foods, suggesting that a colorful array of fruits and vegetables, including those rich in carotenoids, vitamin C, and selenium, can further enhance long-term health outcomes.

One of the notable insights from the research is the role of inflammation in these health benefits. While the study suggests a modest contribution of reduced inflammation to the overall mortality benefit, it still highlights the complex interaction between diet, inflammation, and cholesterol levels. This finding reinforces the importance of managing inflammation as part of a comprehensive approach to health, especially for individuals at risk of chronic diseases.

Despite the promising results, the study's limitations, such as the reliance on self-reported dietary data, should be considered when interpreting these findings. However, the overall message remains clear: a diet rich in antioxidants, particularly those derived from whole foods, can support better cholesterol management and potentially extend life expectancy.

Sources:

• Have High Cholesterol? These Foods Could Lower Your Mortality Risk by 21%, New Study Says