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, 21% with A, and 14% with SNA.

Vitamins may, however, lower restenosis rates ▸ Restenosis after PTCA is a major clinical problem, and apart from stents, no treatment has shown convincing benefits. Treatment with a combination of folic acid, vitamin B12, and pyridoxine significantly reduced homocysteine concentrations and decreased the rate of restenosis (9.6% v 37.6%, p = 0.01) and the need for revascularisation of the target lesion (10.8% v 22.3%, p = 0.047) after coronary angioplasty.

Eat more often to lower cholesterol! ▸ Smaller, more frequent meals are healthier than one or two big meals. The …