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Published on: November 10, 2017
High-dose alpha-tocopherol therapy does not affect HDL subfractions in patients with coronary artery disease on
Uma Singh1, James Otvos, Amitava Dasgupta
1University of California Davis Medical Center, Sacramento, California 95817, USA.
Insights
High-dose alpha-Tocopherol (AT) did not alter HDL subfractions in patients with coronary artery disease. This suggests AT does not negatively interact with statin therapy, contrary to previous concerns.
Area of Science:
- Cardiovascular Research
- Nutritional Science
- Pharmacology
Background:
- High-density lipoprotein (HDL) subfractions, especially large HDL (HDL2), correlate inversely with coronary artery disease (CAD) severity.
- alpha-Tocopherol (AT) is the primary plasma lipid-soluble antioxidant.
- Prior studies suggested antioxidant cocktails or vitamins combined with simvastatin-niacin (S-N) therapy might attenuate beneficial HDL2 increases seen with S-N alone.
Purpose of the Study:
- To investigate the effect of high-dose alpha-Tocopherol (AT) therapy alone on HDL subfractions in patients with stable coronary artery disease (CAD).
- To determine if AT therapy influences HDL particle concentrations or serum apolipoprotein A1 levels over a 2-year period.
Main Methods:
- A prospective, placebo-controlled study involving 127 patients with stable CAD.
- Randomization to receive high-dose RRR-alpha-Tocopherol (AT) (1200 IU/day) or placebo for 2 years.
- Analysis of HDL subfractions (small, medium, large particles) using nuclear magnetic resonance spectroscopy.
Main Results:
- alpha-Tocopherol (AT) concentrations increased significantly in the AT group, confirming adherence.
- No significant differences were observed between AT and placebo groups in total cholesterol, triglycerides, LDL-cholesterol, or HDL-cholesterol.
- AT therapy did not alter the concentrations of total, small, medium, or large HDL particles compared to baseline or placebo.
- Serum apolipoprotein A1 concentrations remained unchanged after 2 years of AT therapy.
Conclusions:
- High-dose alpha-Tocopherol (AT) therapy for 2 years does not negatively impact HDL subfractions or apolipoprotein A1 in CAD patients on statin therapy.
- The previously suggested negative interaction between antioxidant cocktails and statin therapy cannot be attributed to alpha-Tocopherol (AT) alone.
Background:
Subfractions of HDL, particularly large HDL (HDL2), are inversely correlated with the severity of coronary artery disease (CAD). alpha-Tocopherol (AT) is the main lipid-soluble antioxidant in plasma. Results of a previous small study (n = 44) suggested that either a combination of an antioxidant cocktail [800 IU/day 2R,4'R,8'R-(RRR)-AT plus 1 g vitamin C, 25 mg beta-carotene, and 100 microg selenium] or individual antioxidant vitamins combined with simvastatin-niacin (S-N) therapy attenuated the protective increase in HDL2 seen with S-N alone. Few data are available on the effect of AT therapy alone on HDL subfractions, which we addressed in this study.
Methods:
In a prospective placebo-controlled study, we randomized 127 patients with stable CAD to receive high-dose RRR-AT (1200 IU/day for 2 years) or placebo. HDL subfractions (small, medium, and large HDL particles) were analyzed by nuclear magnetic resonance spectroscopy.
Results:
AT concentrations significantly increased in the AT arm but not with placebo. No differences were noted between AT and placebo groups in concentrations of total cholesterol, triglyceride, LDL-cholesterol, or HDL-cholesterol. AT therapy did not affect total, small, medium, or large HDL particles compared with baseline or placebo. Furthermore, serum apolipoprotein A1 concentrations did not change after 2 years AT therapy as compared with baseline.
Conclusions:
High-dose AT therapy administered for a 2-year period does not negatively affect either HDL subfractions or apolipoprotein A1 in patients with CAD on statin therapy. Thus the negative interaction previously proposed between antioxidant cocktail and statin therapy cannot be attributed to AT.
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