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CLINICAL STUDIES

Vitamin E administration improves impairment of endothelium-dependent vasodilation in patients with coronary spastic angina

^a Division of Cardiology, Kumamoto University School of Medicine, Kumamoto, Japan

Manuscript received March 13, 1998; revised manuscript received July 2, 1998, accepted July 24, 1998.

Address for correspondence: Dr. Hirofumi Yasue, Division of Cardiology, Kumamoto University School of Medicine, Honjo 1-1-1, Kumamoto City, Japan 860

Objectives. We examined the effects of oral administration of vitamin E, an antioxidant, on endothelium-dependent vasodilation in patients with coronary spastic angina.

Background. We have recently reported that endothelium-dependent vasodilation is impaired in patients with coronary spastic angina (CSA). Furthermore, it is known that oxidative stress may play an important role in the impairment of endothelium-dependent vasodilation in cardiovascular diseases.

Methods. With the ultrasound technique, flow-dependent vasodilation of the brachial arteries during reactive hyperemia was examined before and after treatment for a month with either oral administration of vitamin E (-tocopherol acetate, 300 mg/day) or placebo, which is randomly assigned, in patients with CSA (n = 60).

Results. Before treatment, patients with CSA had impaired flow-dependent vasodilation, lower plasma levels of -tocopherol and higher plasma levels of thiobarbituric acid reactive substances (TBARS), as compared with age- and sex-matched control subjects (n = 60) (flow-dependent vasodilation: 3.1 ± 1.8 vs. 7.1 ± 2.5%, p < 0.001; -tocopherol levels: 8.9 ± 1.8 vs. 10.8 ± 1.8 µg/ml, p < 0.001). In patients with CSA, treatment with vitamin E restored flow-dependent vasodilation (3.1 ± 1.7 vs. 8.3 ± 2.0%, p < 0.001), and this improvement was associated with the decreases in plasma TBARS levels and anginal attacks.

Conclusions. The results indicate that vitamin E treatment improved endothelium-dependent vasodilation and decreased plasma TBARS levels in patients with CSA. Thus, increased oxidative stress may contribute to endothelial dysfunction and anginal attacks in patients with CSA.

Abbreviations and Acronyms   ANOVA = analysis of variance   CSA = coronary spastic angina   NO = nitric oxide   TBARS = thiobarbituric acid reactive substances

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