The Beating Goes On
Report Shows Antioxidants Interfere With an Effective Therapy for Heart Disease
By Christopher Wanjek
Special to The Washington Post
Tuesday, August 14, 2001; Page HE01
Antioxidant supplements -- vitamins E and C, beta carotene and selenium -- appear to reduce the effectiveness of an important drug therapy for heart disease, according to a report published last week in a peer-reviewed journal of the American Heart Association (AHA). When added to a therapy consisting of a statin drug and niacin, the supplements suppressed increases in HDL, the so-called good cholesterol. Whether taken alone or with the statin-niacin therapy, the antioxidants had no effect on LDL, the bad cholesterol.
These results come at a time when record numbers of people are taking statins and antioxidant supplements. New federal guidelines on blood cholesterol management issued in May could triple the number of Americans taking statins in the next few years, to 36 million. Up to 30 percent of the population currently takes antioxidant supplements daily, often for their presumed benefits to the heart, according to the AHA.
"You can take antioxidants, but they won't be any good at preventing coronary artery disease," said Greg Brown, professor of medicine at the University of Washington School Medicine in Seattle and an author of the report, which appears in the journal Atherosclerosis, Thrombosis and Vascular Biology. "And if you are taking antioxidants while on lipid therapy [with statin drugs], then you are interfering with a proven therapy."
In a year-long study, 153 patients with coronary artery disease were divided into four groups and given a combination of simvastatin (a statin known commercially as Zocor) plus niacin (a vitamin that at high doses lowers bad cholesterol and raises good); a dose of antioxidant vitamins commonly called an "antioxidant cocktail"; both the simvastatin-niacin combo and the antioxidants; or a placebo.
People in the group that received only the statin-niacin combo saw a 25 percent increase in their HDL. Those who took statin-niacin plus antioxidant saw only an 18 percent increase in HDL. The placebo and antioxidant-only groups saw no improvement in HDL.
Further, the antioxidants mostly affected HDL(2), the best part of good cholesterol. Patients in the group taking statins plus niacin boosted their HDL(2) count by 42 percent. The groups taking antioxidants saw no increase in HDL(2).
The main goal of statins is to lower LDL. In the study, antioxidants did not affect LDL levels.
"We are convinced that statins are winners," said Lewis Kuller of the University of Pittsburgh School of Public Health, who wrote an editorial accompanying the statin report. "In past studies we have found that antioxidants are not effective and often harmful. I'd go with a winner, not a loser."
Researchers cannot, however, draw any conclusions about the effects of individual antioxidants from this study, according to Ronald Krauss, head of the Department of Molecular Medicine at the Lawrence Berkeley National Laboratory in Berkeley, Calif.
"It would be premature to make any recommendations until the results of the study can be confirmed, preferably with use of specific antioxidants" rather than the cocktail, Krauss said by e-mail.
© 2001 The Washington Post Company