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    Study: Antioxidant Supplements May Decrease Effectiveness of Heart Drug

    Although so-called antioxidant nutrients like vitamins C and E and beta-carotene are reputed to help prevent or treat a variety of ailments, their performance in rigorous scientific studies typically has been disappointing. Another such investigation, appearing in the August 9 issue of the journal Arteriosclerosis, Thrombosis, and Vascular Biology, suggests that supplements of such compounds can actually diminish the effectiveness of drugs used to lower blood cholesterol levels.

    Marian C. Cheung, Ph.D. and colleagues at the University of Washington School of Medicine in Seattle, investigated the effects of combining several antioxidant nutrients with standard treatments in people who had diagnosed coronary artery disease (CAD). Although elevated LDL, orÓ"bad" cholesterol, is widely understood to be a risk factor for heart disease, low levels of HDL, or Ó"good"Ó cholesterol, may also increase risk of CAD.Ó

    People whose HDL cholesterol is low, according to Dr. Cheung and coauthors, may be treated using a so-called statin drug (which decreases LDL and increases HDL levels) alone or in combination with the B-vitamin niacin, which also improves the blood cholesterol profile. The researchers investigated whether adding several antioxidant nutrients to the statin-niacin treatment would be of further benefit.

    Subjects of the study were 153 patients, 135 men and 18 women ranging in age between 33 and 74 years (mean age was 54 years). All had CAD-they had been diagnosed with at least one coronary artery that was 50 percent blocked or 3 arteries that were 30 percent blocked.

    Study participants all were counseled in lifestyle improvement, including information on smoking cessation, weight reduction, increasing activity levels, and improving their diets.Ó Each person was assigned at random to one of four treatments: 1) a statin drug plus niacin; 2) supplements of the antioxidant nutrients beta-carotene, vitamins C and E, and the mineral selenium; 3) the statin drug, niacin and the antioxidants; and 4) inactive pills (placebos). At the start of the study, and after one year of treatment, the subjects' blood levels of total cholesterol, LDL and HDL cholesterol were measured.

    At the one year point, the researchers found that the participants in group 1, who had the standard statin + niacin treatment, had lowered their total cholesterol by 25 percent compared to initial values, and that those who also took antioxidants (group3) had similarly decreased total cholesterol by 26 percent. These groups also had similar decreases in LDL cholesterol (34 and 31 percent declines).

    In contrast, the effects of these treatments on HDL cholesterol were quite different. Subjects on the standard treatment (group 1) significantly increased their HDL level by 41 percent, while those who also took antioxidants increased by only 18 percent compared to baseline values. This smaller increase was not statistically significant.

    The investigators also looked at a sub-class of HDL cholesterol-the so called HDL(2) component-which is thought to be the most protective part of the HDL. They found that the standard treatment produced a significant 42 percent increase in HDL(2) over the course of the study, but that there was no change in HDL(2) in subjects who took the statin+niacin+antioxidant therapy.

    In their discussion of these results, the authors commentedÓ" to our surprise, when S-N [drug + niacin, group 1] was taken with the antioxidants, the potentially beneficial response of HDL to S-N was markedly attenuated." They warned that " because large quantities of these antioxidants are consumed in the United states, their interaction with lipid therapy may have important clinical implications."

    Lewis H. Kuller, M.D., Dr. P.H. from the University of Pittsburgh concurred in an editorial accompanying the report.Ó "It will be important that physicians advise their patients that the use of antioxidants could be hazardous, especially in combination with lipid lowering drugs [statins]" - he emphasized.Ó



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