Complementary Alternative Cardiovascular Medicine

Chapter 5 / Vitamin Therapy and CVD 67
a result of side effects. The dose of niacin used was similar to that found
in a B-complex supplement.
There is numerous circumstantial evidence for the benefit of vitamins
to prevent CVD, but there is no convincing evidence in the literature in
favor of supplements of antioxidant vitamins. Vitamin E, β-carotene,
and vitamin C can inhibit the oxidative modification of LDL. This action
could positively influence the atherosclerotic process and the progression
of CVD. However, clinical trials with β-carotene indicate that
supplements should not be taken. The data for vitamin C are limited, and
the data for vitamin E from the ATBC study (150 mg/d), CHAOS (400–
800 mg/d), GISSI (300 mg/d), HOPE (400 mg/d), and HPS (600 mg/d)
suggest the absence of relevant clinical effects of antioxidant vitamins
on CVD risk. Additional concerns are that vitamins E and C can act as
pro-oxidants (60), and vitamin E may interfere with the benefits of cholesterol-lowering
drugs by lowering HDL 2 levels and preventing HDL 2
rise with lipid-altering therapy (61). Therefore, recommendation of vitamin
supplements is difficult to justify at this time. A recent report on
self-selected vitamins E and C or multivitamins by 83,639 US male
physicians for a 5.5-yr period was not associated with a significant decrease
in total CVD or CHD mortality (62).
Long-term randomized placebo-controlled trials are the gold standard
for establishing the benefits of treatment to prevent disease. There
are ongoing primary and secondary prevention trials with vitamin E, βcarotene,
and C supplementation. These studies have included healthy
men and women and patients with CVD. The evidence currently available
does not support any public health policy recommendations for
antioxidant supplementation. Meanwhile, the American population
should be encouraged to increase its fruit and vegetable consumption
because of their unique antioxidant content, as well as low-fat and highfiber
properties.
Optimizing nutrient intake must be achieved by improving diet. Foods
have hundreds of antioxidants and other nutrients that act in synergy to
promote health. It has been difficult so far to determine which components
of such diets provide the protection against CVD. Diets that are
plant based, with fruits and vegetables and whole grains, have consistently
shown to be cardioprotective in large prospective cohort studies.
A clinically sound approach is to encourage the American population to
consume a diet consisting of whole grains, legumes, several fruits and
vegetables, nuts, seeds, fatty fish (such as salmon and mackerel), and
nonfat or low-fat dairy foods; include physical activity on a daily basis;
and maintain a healthy body weight.