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Drug, Vitamin Therapy Can Reduce Risk of Heart Attack - 2001-12-04

A combination of drug and vitamin therapy can reduce the risk of heart attack by 70 percent, according to an article in the New England Journal of Medicine. At the same time, researchers found that some vitamins thought to prevent heart disease do not.

In the study, researchers at the University of Washington wanted to see how far down they could drive the risk of heart disease using proven therapies. The 160 patients involved in the study had some degree of heart disease and reduced levels of HDL, also known as the "good" cholesterol. Low levels of HDL have been associated with increased risk of heart disease and heart attack. Approximately 40 percent of people with heart disease have low HDL.

To correct the low HDL, one-fourth of the participants were given niacin a vitamin that's been shown to increase levels of good cholesterol. They also received simvastatin, a drug that studies have showed lowers LDL, or bad cholesterol by 30 percent or more.

A second group of patients got a cocktail of so-called anti-oxidant vitamins, including vitamins C, E, beta carotene and selenium. A third group got simvastatin, niacin and the anti-oxidant mixture. And a fourth group was given a placebo or sugar pills that they thought were real.

University of Washington cardiologist Greg Brown led the study. At the end of three years, Dr. Brown says by far, heart patients on the niacin-simvastatin combination did the best. Dr. Brown said, "Essentially, with that combination you can stop now with three different studies that we have done. You can stop the disease from progressing in its tracks. It just stops; on average, it gets a little better. And the second thing is the frequency of clinical events goes down into the order of 70 percent risk reduction. So, the combination I think will become a more commonly used one."

In other words, patients on the niacin-simvastatin combination had the fewest heart attacks and visits to hospital emergency rooms for chest pain.

While those on anti-oxidants fared better than the placebo group, the study found no benefit to the vitamins touted as heart healthy.

Dr. Brown's group made a surprising finding that goes beyond the results of previous studies showing no benefit to anti-oxidants. "In fact," he said, "it appears that the anti-oxidants interfere with the ability of the lipid drugs to raise HDL. So, they actually have an adverse effect."

Jane Freedman is a cardiologist and drug researcher at Boston University in Massachusetts. Dr. Freedman says while anti-oxidant vitamins are necessary for good health, she agrees they may not be beneficial in the treatment of heart disease.

However, she says more studies are needed to figure out why University of Washington researchers got the results they did. "Because they used an anti-oxidant cocktail," she said, "it's unclear which of the anti-oxidants, or was it a specific dose or combination, caused the effect. It was a fairly unexpected effect. So, it's not exactly easy to explain why it happened.

While anti-oxidant vitamins such as vitamins C, E and beta carotene may do more harm than good, Dr. Freedman is intrigued by the study's chief finding that raising "good" cholesterol levels has a dramatic effect on reducing the risk of heart disease. Dr. Freedman says HDL-raising therapies, like niacin, may turn out to be a very effective way to treat heart without too much effort.