PJ Letters: Antioxidants

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The Pharmaceutical Journal Vol 267 No 7167 p425-429
29 September 2001

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Letters to the Editor

Antioxidants

Not such bad news

From Dr R. E. Lister, FIB Biol

I would like to comment on the news item “Further bad news about antioxidants” (PJ, 11 August, p186).

The headline is somewhat alarmist as the so-called bad news only applies to a specific combination of a statin (simvastatin) and niacin. This is a combination not widely used in Britain and the results of the study by Cheung and others¹ should not be used to condemn the use of antioxidant supplements in cardiovascular disease.

Cholesterol on its own whether HDL or LDL only presents a serious risk in its oxidised form. This activates macrophages and may result in the formation of atherosclerotic plaques and thickening of the intima with an increased risk of atherosclerosis. Numerous studies have shown that antioxidants of the type used in this study can inhibit cholesterol oxidation both in vitro and in vivo.^2,3 Another recent study⁴ using a direct measure of arterial wall thickness, found that an antioxidant combination of vitamins E and C can retard significantly the progress of atherosclerosis.

In my opinion this is of greater relevance than a failure to elevate HDL, the finding upon which the headline was based. A large UK study of 7,000 adults concluded that low HDL is not a major risk factor for coronary heart disease.⁵ A UK Government report has shown that major sections of the population do not reach the RNI for vitamin C, vitamin E and selenium from diet alone. Dietary supplementation with antioxidant vitamins can provide effective insurance against such shortcomings.

References

1. Cheung MC, Zhao XQ, Chait A, Albers JJ, Brown BG. Antioxidant supplements block the response of HDL to simvastatin-niacin therapy in patients with coronary artery disease and low HDL. Arterioscler Thromb Vasc Biol 2001;8: 1320–6.

2. Witztum JL. The oxidation hypothesis of atherosclerosis. Lancet 1994;344:793–5.

3. Mosca L, Rubenfire M, et al. Antioxidant nutrient supplementation reduces the susceptibility of low density lipoprotein to oxidation in patients with coronary heart disease. J Am Coll Cardiol 1997;30:392–9.

4. Salonen JT, Nyyssonen K, Salonen R et al. Antioxidant supplementation in atherosclerosis prevention (ASAP) study: a randomized trial of the effect of vitamins E and C on 3-year progression of carotid atherosclerosis. J Int Med 2000;248:377–86.

5. Pocock SJ, Shaper AG, Phillips AN, Walker N, Whitehead TP. High density lipoprotein cholesterol is not a major risk factor for ischaemic heart disease in British men. Br Med J Clin Res 1986;292:515–9.

R. E. Lister
Beaconsfield, Buckinghamshire

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