CORRESPONDENCE: LETTER TO THE EDITOR
Statins and Antioxidant Vitamins: Should Co-Administration Be Avoided?
Dimitris Tousoulis, MD, PhD, FACC*,
Charalambos Antoniades, MD and
Christodoulos Stefanadis, MD, FACC, FESC
* Athens University Medical School, Hippokration Hospital, Vasilissis Sophias 114, 115 28 Athens, Greece (Email: tousouli{at}med.uoa.gr).
In the interesting study by Arad et al. (1), co-administration of atorvastatin (20 mg/day) and high-dose antioxidant vitamins C (1 g/day) and E (1,000 IU/day) failed to decrease the progression of coronary calcification, whereas a borderline decrease of cardiovascular events was observed. Based on the fact that previous studies have shown that statins do decrease both the progression of coronary artery calcification and cardiovascular events (2), the investigators proposed that the atorvastatin dosage they used was low, and they suggested that their population was not large enough to detect any differences. However, another possibility might be considered: The results of the present study may reflect a negative effect of antioxidant vitamins (especially vitamins C and E), which could interfere with lipoprotein metabolism, preventing the statin-induced increase of high-density lipoprotein (HDL)-2 subfraction, as has been proposed in the past (3). Indeed, in a study by Brown et al. (4), it was shown that co-administration of statin and antioxidant vitamins C and E partly prevents the beneficial effects of statins on cardiovascular outcome. Additionally, we (5) have recently demonstrated that, although low-dose atorvastatin treatment (10 mg/day) improves endothelial function in patients with ischemic heart disease, this effect is abolished when vitamin E (400 IU/day) is co-administered. Therefore, further studies examining the effect of atorvastatin 10 to 20 mg/day alone on the progression of coronary artery calcification and clinical events rate are required before any conclusion is made.
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1. Arad Y, Spadaro LA, Roth M, Newstein D, Guerci AD. Treatment of asymptomatic adults with elevated coronary calcium scores with atorvastatin, vitamin C, and vitamin Ethe St. Francis Heart Study Randomized Clinical Trial. J Am Coll Cardiol 2005;46:166-172.[Abstract/Free Full Text]2. Achenbach S, Ropers D, Pohle H, et al. Influence of lipid-lowering therapy on the progression of coronary artery calcification. A prospective evaluation Circulation 2002;106:1077-1082.[Abstract/Free Full Text] 3. Cheung M, Zhao XQ, Chait A. Antioxidant supplements block the response of HDL to simvastatin–niacin therapy in patients with coronary artery disease and low HDL Arterioscler Thromb Vasc Biol 2001;21:1320-1326.[Abstract/Free Full Text] 4. Brown BG, Zhao XQ, Chait A. Simvastatin and niacin, antioxidant vitamins or the combination for the prevention of coronary disease N Engl J Med 2001;345:1583-1592.[Abstract/Free Full Text] 5. Tousoulis D, Antoniades C, Vasiliadou C, et al. Effects of combined administration of low dose atorvastatin and vitamin E on inflammatory markers and endothelial function in patients with heart failure Eur J Heart Fail 2005;7:1126-1132.[CrossRef][Web of Science][Medline]
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