Statins good, antioxidants bad?
By DrRich
Many newspaper headlines during the first week of December, 2001, citing a new study from the New England Journal of Medicine, can be boiled down to: statins good, antioxidants bad. While that is indeed one way to interpret the results, as usual the truth is a bit more complicated than that.
In this study, 160 patients who had proven coronary artery disease, low HDL cholesterol levels, and normal LDL cholesterol levels were randomized to receive one of four treatment schemes: 1) simvastatin (the statin drug that best affects HDL levels) plus niacin; 2) antioxidants; 3) simvastatin plus niacin plus antioxidants; or 4) placebos (sugar pills.) (The antioxidants used in this study were a combination of vitamin E, vitamin C, beta carotene, and selenium.)After three years, differences were measured in the incidence of cardiovascular events (death, heart attack, stroke or the need for angioplasty or bypass), and cardiac catheterization was repeated to measure any changes in coronary artery blockages.
Results:
1. Effect on HDL levels
- HDL levels increased significantly with simvastatin+niacin
- HDL levels did not increase with placebo, or with antioxidants
- HDL levels did not increase as much when antioxidants were added to simvastatin+niacin (i.e., antioxidants worsened the benefit seen with simvastatin + niacin alone)
2. The frequency of cardiovascular events
- With simvastatin + niacin 3%
- With simvastatin + niacin + antioxidants 14%
- With antioxidants alone 21%
- With placebo 24%
3. Degree of blockage in coronary arteries
- With simvastatin + niacin 0.4% better
- With simvastatin + niacin + antioxidants 0.7% worse
- With antioxidants alone 1.8% worse
- With placebo 3.9% worse
What this means:
- For patients who have coronary artery disease, and who have low HDL levels and normal LDL levels, the combination of simvastatin plus niacin substantially increases HDL levels, reduces the frequency of bad clinical events, and actually improves coronary artery blockages.
- In these patients, antioxidants alone somewhat reduce the frequency of bad clinical events, and slow the worsening of coronary artery blockages.
- In these patients, when added to a regimen of simvastatin + niacin, antioxidants worsen the benefits of those drugs.
Note the following:
- These results cannot be applied to the "typical" high cholesterol patient, whose main cholesterol abnormality is an increased LDL and not a reduced HDL.
- Results that might have been obtained with different antioxidant regimens cannot be stated from this study.
- This study strongly supports the hypothesis that increasing HDL levels is an important therapeutic target in people with low HDL levels.
The bottom line
Probably the most important conclusion from this study is that patients with coronary artery disease and reduced HDL levels should be tried on therapy aimed at increasing HDL levels. The combination of simvastatin plus niacin appears to do this.
Further, this study adds to the growing evidence that there is no compelling reason for patients with coronary artery disease to take antioxidants. However, more studies are needed to measure whether different regimens of antioxidants, or whether other patient populations, might benefit from these supplements.
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