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FOR SUPPORTERS OF VITAMINS
C AND E: (May 2003) The evidence has never supported the use of vitamin C in prevention of coronary heart disease and heart attacks. The recent evidence relating to vitamin E is also discouraging. This new study on use of these antioxidants is interesting, but it is of uncertain general applicability because the subjects were forty persons who had undergone heart transplantation. One-half were given vitamin C, 1,000 milligrams, and vitamin E, 800 milligrams, daily for one year. The coronary blood vessels were studied by a sophisticated technique for the presence of arteriosclerosis plaque development. During that one year period, the evidence of arteriosclerosis in the coronary blood vessels increased by 8 percent in the twenty controls, but virtually no increase occurred in those given vitamins E and C. The investigators point out that post-transplantation arteriosclerosis is an immune reaction in which oxidant stress is likely to be important - and, therefore, antioxidants might well be effective. The authors concluded "supplementation with antioxidant vitamins C and E retards the early progression of transplant-associated coronary arteriosclerosis". Commentary: This study is reviewed because it gives a little hope that antioxidants may be useful in prevention of coronary arteriosclerosis and heart attacks. But, as the authors point out, arteriosclerosis after heart transplantation is very different from the usual coronary arteriosclerosis in regard to the mechanisms underlying its development; that means the results in these patients cannot be generalized. Additionally, of course, only a small number of subjects were involved, and the study took place only over one year, so it is not clear whether antioxidants would produce long-term benefits.
This is a good study; it emphasizes that the debate over the value of antioxidants in prevention of coronary heart disease and heart attacks is not ended. But, the findings, if confirmed, would apply only to this special population. The bottom line in regard to general use of these antioxidants for possible heart disease prevention is, for the present, still that: • there is no reason to advocate vitamin C as a preventive for coronary heart disease and heart attacks in normal persons or in those with risk factors for heart attacks, or in those with proved coronary heart disease • the evidence in regard to vitamin E is increasingly discouraging; it could still turn out to be useful as a preventive, but that will require better supporting evidence than we have now. Fang, J.C., et al. Effect of vitamins A and E on progression of transplant-associated arteriosclerosis. Lancet. 359 (March 30) Pgs 1108-1113. 2002.
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