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Heart 1998;79:454-458; doi:10.1136/hrt.79.5.454
Copyright © 1998 BMJ Publishing Group Ltd & British Cardiovascular Society

Heart 1998;79:454-458 ( May )

Effects of alpha  tocopherol and beta  carotene supplements on symptoms, progression, and prognosis of angina pectoris

J M Rapola,a J Virtamo,a S Ripatti,a J K Haukka,a J K Huttunen,a D Albanes,b P R Taylor,b O P Heinonenc

a National Public Health Institute, Helsinki, Finland, b National Cancer Institute, Bethesda, Maryland, USA, c Department of Public Health, University of Helsinki, Helsinki, Finland

Correspondence to: Dr J M Rapola, National Public Health Institute, Department of Nutrition, Mannerheimintie 166, FIN-00300, Helsinki, Finland. email: Janne.Rapola{at}ktl.fi

Accepted for publication 17 November 1997

Objective---To evaluate the effects of alpha  tocopherol and beta  carotene supplements on recurrence and progression of angina symptoms, and incidence of major coronary events in men with angina pectoris.
Design---Placebo controlled clinical trial.
Setting---The Finnish alpha  tocopherol beta  carotene cancer prevention study primarily undertaken to examine the effects of alpha  tocopherol and beta  carotene on cancer.
Subjects---Male smokers aged 50-69 years who had angina pectoris in the Rose chest pain questionnaire at baseline (n = 1795).
Interventions---alpha tocopherol (vitamin E) 50 mg/day, beta  carotene 20 mg/day or both, or placebo in 2 × 2 factorial design.
Main outcome measures---Recurrence of angina pectoris at annual follow up visits when the questionnaire was readministered; progression from mild to severe angina; incidence of major coronary events (non-fatal myocardial infarction and fatal coronary heart disease).
Results---There were 2513 recurrences of angina pectoris during follow up (median 4 years). Compared to placebo, the odds ratios for recurrence in the active treatment groups were: alpha  tocopherol only 1.06 (95% confidence interval (CI) 0.85 to 1.33), alpha  tocopherol and beta  carotene 1.02 (0.82 to 1.27), beta  carotene only 1.06 (0.84 to 1.33). There were no significant differences in progression to severe angina among the groups given supplements or placebo. Altogether 314 major coronary events were observed during follow up (median 5.5 years) and the risk for them did not differ significantly among the groups given supplements or placebo.
Conclusions---There was no evidence of beneficial effects for alpha  tocopherol or beta  carotene supplements in male smokers with angina pectoris, indicating no basis for therapeutic or preventive use of these agents in such patients.

Keywords: antioxidants;  angina pectoris;  prevention;  vitamin supplements

© 1998 by Heart
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