Complementary Alternative Cardiovascular Medicine

66 Alternative Cardiovascular Medicine
The acute effects of 3 g of vitamin C infusion (48) was studied in 11
subjects with idiopathic dilated cardiomyopathy. The authors demonstrated
that endothelium dysfunction can be acutely reversed. Vitamin C
is a water-soluble antioxidant and is an efficient scavenger of oxygen
free radicals, suggesting an increased availability of NO.
The administration of vitamin C suppresses endothelial cell apoptosis
(programmed cell death), suggesting the functional benefit of vitamin C
supplementation on endothelial function (49). Patients were randomized
to receive vitamin C (2.5 g) or placebo, according to a sequential administration
protocol combining iv bolus with oral application of the treatment
(2 g vitamin C) and placebo for 3 d to patients with CHF.
Vitamins have been studied in combinations, particularly vitamins C
and E. In a double-blind prospective study (50), 40 patients (0–2 yr after
cardiac transplantation) were randomly assigned vitamin C 500 mg plus
400 IU vitamin E twice daily (n = 19) or placebo (n = 21) for 1 yr. The
primary endpoint was the change in average intimal index (plaque area
divided by the vessel area) measured by intravascular ultrasonography.
Coronary endothelium-dependent vasoreactivity was also assessed.
During the 1-yr treatment, the intimal index increased in the placebo
group by 8% but did not change significantly in the treatment group
(0.8%). Coronary endothelial function remained stable in both groups.
This study suggested that supplementation with vitamins C and E retards
the early progression of transplant-associated coronary arteriosclerosis.
Supplementation with 500 mg of vitamins C, 400 IU of E and 12 mg
β-carotene or 1000 mg of vitamin C, 800 IU of E, and 24 mg β-carotene
did not significantly alter brachial reactivity in a 12-wk trial of 18 nonsmokers
with established CAD but no diabetes (51).
Niacin
In patients with hyperlipidemia, niacin decreases morbidity and
mortality rates (52). Niacin is most effective in increasing HDL C
(53,54). The combination of statins and low-dose niacin is effective in
improving the LDL C/HDL C ratio rather than the drug alone (55–58).
The doses of niacin ranged from 1000 to 3000 mg/d in these studies.
These doses usually have side effects, including flushing, gastrointestinal
(GI) problems, and liver function test abnormalities. In a recent small
study (59), the addition of very low-dose niacin 50 mg administered
twice daily for 3 mo, increased the mean HDL cholesterol by 2.1 mg/dL
vs –0.56 mg/dL for the placebo group (p = .0246). In addition, no major
side effects were noted and no patients stopped the study medication as