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ARTICLE |

Serial Coronary Angiographic Evidence That Antioxidant Vitamin Intake Reduces Progression of Coronary Artery Atherosclerosis

Howard N. Hodis, MD; Wendy J. Mack, PhD; Laurie LaBree, MS; Linda Cashin-Hemphill, MD; Alex Sevanian, PhD; Ruth Johnson, RD, MA; Stanley P. Azen, PhD
JAMA. 1995;273(23):1849-1854. doi:10.1001/jama.1995.03520470057032.
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Objective.  —To explore the association of supplementary and dietary vitamin E and C intake with the progression of coronary artery disease.

Design.  —A subgroup analysis of the on-trial antioxidant vitamin intake database acquired in the Cholesterol Lowering Atherosclerosis Study, a randomized, placebo-controlled, serial angiographic clinical trial evaluating the risk and benefit of colestipol-niacin on coronary artery disease progression.

Setting.  —Community- and university-based cardiac catheterization laboratories.

Subjects.  —A total of 156 men aged 40 to 59 years with previous coronary artery bypass graft surgery.

Intervention.  —Supplementary and dietary vitamin E and C intake (nonrandomized) in association with cholesterol-lowering diet and either colestipol-niacin or placebo (randomized).

Outcome.  —Change per subject in the percentage of vessel diameter obstructed because of stenosis (%S) determined by quantitative coronary angiography after 2 years of randomized therapy on all lesions, mild/moderate lesions (<50%S), and severe lesions (≥50%S).

Results.  —Overall, subjects with supplementary vitamin E intake of 100 IU per day or greater demonstrated less coronary artery lesion progression than did subjects with supplementary vitamin E intake less than 100 IU per day for all lesions (P=.04) and for mild/moderate lesions (P=.01). Within the drug group, benefit of supplementary vitamin E intake was found for all lesions (P=.02) and mild/moderate lesions (P=.01). Within the placebo group, benefit of supplementary vitamin E intake was not found. No benefit was found for use of supplementary vitamin C exclusively or in conjunction with supplementary vitamin E, use of multivitamins, or increased dietary intake of vitamin E or vitamin C.

Conclusions.  —These results indicate an association between supplementary vitamin E intake and angiographically demonstrated reduction in coronary artery lesion progression. Verification from carefully designed, randomized, serial arterial imaging end point trials is needed.(JAMA. 1995;273:1849-1854)

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