© 2002 by Heart
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Ischaemic heart disease
Antioxidants may attenuate the benefits of lipid lowering 
In a three year, double blind trial, 160 patients with coronary disease, low high density lipoprotein (HDL) cholesterol concentrations, and normal low density lipoprotein (LDL) cholesterol concentrations were randomly assigned to receive one of four regimens: simvastatin+niacin (SN), antioxidant vitamins C and E plus carotene and selenium (A), simvastatin+niacin plus antioxidants (SNA), or placebos. The end points were arteriographic evidence of a change in coronary stenosis and the occurrence of major adverse cardiac events (MACE): death, myocardial infarction, stroke, or revascularisation. LDL and HDL cholesterol concentrations were unchanged in the A and placebo groups, but changed substantially (by -42% and +26%, respectively) in the SN group. The protective increase in HDL with SN was attenuated in the SNA group. This was reflected in greater progression of coronary artery disease and higher MACE rates with SNA: 24% with placebos, 3% with SN alone,
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