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• W2000591923 abstract "In their meta-analysis of relevant randomised trials, Deepak Vivekanathan and co-workers (June 14, p 2017)1Vivekanathan DP Penn MS Sapp SK Hsu A Topol EJ Use of antioxidant vitamins for the prevention of cardiovascular disease: meta-analysis of randomised trials.Lancet. 2003; 361: 2017-2023Summary Full Text Full Text PDF PubMed Scopus (951) Google Scholar note no beneficial effect from vitamin E or β-carotene supplementation in terms of prevention of cardiovascular events. Although this finding contrasts with those of preclinical and epidemiological studies (the latter examining the dietary consumption of antioxidant-rich foods in their natural matrix of fibres), it concurs with results of clinical trials, which in some instances showed an increased risk of cardiovascular diseases after supplementation with β carotene.The implications of this meta-analysis for single-vitamin supplementation are great. However, we have reservations about the wisdom of extending to multivitamins the conclusion that “use of vitamin supplements containing β-carotene and vitamin A […] should be actively discouraged”. Although we appreciate the reasons for caution, such a claim could only come from a meta-analysis of clinical trials done specifically to assess multivitamin supplementation. The few available trials of this sort have generally been encouraging. This finding is not surprising, since the beneficial or harmful outcomes of a single compound can be quite different from those elicited by the same compound within complex mixtures of multiple vitamins and minerals.2Bowry VW Ingold KU The unexpected role of vitamin E (α-tocopherol) in the peroxidation of human low-density lipoprotein.Acc Chem Res. 1999; 32: 27-34Crossref Scopus (200) Google Scholar Total discouragement of multivitamins containing β carotene and vitamin A contrasts with authoritative arguments in support of more rational approaches to their use. For example, Willett and Stampfer3Willett WC Stampfer MJ Clinical practice. What vitamins should I be taking, doctor?.NEngl J Med. 2001; 345: 1819-1824Crossref PubMed Scopus (122) Google Scholar suggest specific recommendation of multivitamin supplements for individuals at high risk—eg, women who might become pregnant, elderly individuals, vegans, those of poor socioeconomic status, and alcoholics—while encouraging healthy lifestyle and diet as a primary strategy.With respect to the plausible mechanisms for the slight increases in mortality associated with β-carotene supplementation, another possibility is that this provitamin behaves as a cocarcinogen, and can produce large amounts of oxygen free radicals.4Paolini M Cantelli-Forti G Perocco P Pedulli GF Abdel-Rahman SZ Legator MS Co-carcinogenic effect of beta-carotene.Nature. 1999; 398: 760-761Crossref PubMed Scopus (173) Google Scholar Although β carotene is an effective trap for singlet oxygen, it is actually a highly equivocal chain-breaking antioxidant. While at a low partial pressure of oxygen—a situation not frequently encountered in non-ischaemic tissues— it can moderately contrast lipid peroxidation, at normal concentrations of oxygen β carotene can propagate the peroxidation process.The lack of a beneficial effect found for vitamin E could also be related to its chemistry, along with certain design limitations of most of the trials considered. When used to prevent LDL from lipid peroxidation, in the absence of adequate quantities of vitamin C, ubiquinol, or other suitable water soluble co-antioxidants, vitamin E (α-tocopherol) can accelerate peroxidation and lipid damage—an occurrence known as tocopherol mediated peroxidation, which is related to LDL particle size and other variables.2Bowry VW Ingold KU The unexpected role of vitamin E (α-tocopherol) in the peroxidation of human low-density lipoprotein.Acc Chem Res. 1999; 32: 27-34Crossref Scopus (200) Google Scholar Only two of the trials included in the meta-analysis involved co-administration of co-antioxidants. In the Heart Protection Study, the relative daily amount of vitamins E and C (600 mg and 250 mg, respectively) respected neither the recommended daily ratios for the two nutrients (15 mg and 90 mg, respectively) nor the correct ratio of consumption in controlled inhibited autoxidation models. The relative amount of the two vitamins was similarly unbalanced in the AREDS trial, in which the prevention of cataract was assessed—not the most obvious marker for oxidative-stress related diseases. In their meta-analysis of relevant randomised trials, Deepak Vivekanathan and co-workers (June 14, p 2017)1Vivekanathan DP Penn MS Sapp SK Hsu A Topol EJ Use of antioxidant vitamins for the prevention of cardiovascular disease: meta-analysis of randomised trials.Lancet. 2003; 361: 2017-2023Summary Full Text Full Text PDF PubMed Scopus (951) Google Scholar note no beneficial effect from vitamin E or β-carotene supplementation in terms of prevention of cardiovascular events. Although this finding contrasts with those of preclinical and epidemiological studies (the latter examining the dietary consumption of antioxidant-rich foods in their natural matrix of fibres), it concurs with results of clinical trials, which in some instances showed an increased risk of cardiovascular diseases after supplementation with β carotene. The implications of this meta-analysis for single-vitamin supplementation are great. However, we have reservations about the wisdom of extending to multivitamins the conclusion that “use of vitamin supplements containing β-carotene and vitamin A […] should be actively discouraged”. Although we appreciate the reasons for caution, such a claim could only come from a meta-analysis of clinical trials done specifically to assess multivitamin supplementation. The few available trials of this sort have generally been encouraging. This finding is not surprising, since the beneficial or harmful outcomes of a single compound can be quite different from those elicited by the same compound within complex mixtures of multiple vitamins and minerals.2Bowry VW Ingold KU The unexpected role of vitamin E (α-tocopherol) in the peroxidation of human low-density lipoprotein.Acc Chem Res. 1999; 32: 27-34Crossref Scopus (200) Google Scholar Total discouragement of multivitamins containing β carotene and vitamin A contrasts with authoritative arguments in support of more rational approaches to their use. For example, Willett and Stampfer3Willett WC Stampfer MJ Clinical practice. What vitamins should I be taking, doctor?.NEngl J Med. 2001; 345: 1819-1824Crossref PubMed Scopus (122) Google Scholar suggest specific recommendation of multivitamin supplements for individuals at high risk—eg, women who might become pregnant, elderly individuals, vegans, those of poor socioeconomic status, and alcoholics—while encouraging healthy lifestyle and diet as a primary strategy. With respect to the plausible mechanisms for the slight increases in mortality associated with β-carotene supplementation, another possibility is that this provitamin behaves as a cocarcinogen, and can produce large amounts of oxygen free radicals.4Paolini M Cantelli-Forti G Perocco P Pedulli GF Abdel-Rahman SZ Legator MS Co-carcinogenic effect of beta-carotene.Nature. 1999; 398: 760-761Crossref PubMed Scopus (173) Google Scholar Although β carotene is an effective trap for singlet oxygen, it is actually a highly equivocal chain-breaking antioxidant. While at a low partial pressure of oxygen—a situation not frequently encountered in non-ischaemic tissues— it can moderately contrast lipid peroxidation, at normal concentrations of oxygen β carotene can propagate the peroxidation process. The lack of a beneficial effect found for vitamin E could also be related to its chemistry, along with certain design limitations of most of the trials considered. When used to prevent LDL from lipid peroxidation, in the absence of adequate quantities of vitamin C, ubiquinol, or other suitable water soluble co-antioxidants, vitamin E (α-tocopherol) can accelerate peroxidation and lipid damage—an occurrence known as tocopherol mediated peroxidation, which is related to LDL particle size and other variables.2Bowry VW Ingold KU The unexpected role of vitamin E (α-tocopherol) in the peroxidation of human low-density lipoprotein.Acc Chem Res. 1999; 32: 27-34Crossref Scopus (200) Google Scholar Only two of the trials included in the meta-analysis involved co-administration of co-antioxidants. In the Heart Protection Study, the relative daily amount of vitamins E and C (600 mg and 250 mg, respectively) respected neither the recommended daily ratios for the two nutrients (15 mg and 90 mg, respectively) nor the correct ratio of consumption in controlled inhibited autoxidation models. The relative amount of the two vitamins was similarly unbalanced in the AREDS trial, in which the prevention of cataract was assessed—not the most obvious marker for oxidative-stress related diseases. Antioxidant vitamins for prevention of cardiovascular diseaseAuthors' reply Full-Text PDF" @default.
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• W2000591923 title "Antioxidant vitamins for prevention of cardiovascular disease" @default.
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