A new method of growing arteries could lead to a “biological bypass” – or a non-invasive way to treat coronary artery disease, Yale School of Medicine researchers report with their colleagues in the April issue of Journal of Clinical Investigation.

Coronary arteries can become blocked with plaque, leading to a decrease in the supply of blood and oxygen to the heart. Over time this blockage can lead to debilitating chest pain or heart attack. Severe blockages in multiple major vessels may require coronary artery bypass graft surgery, a major invasive surgery.

“Successfully growing new arteries could provide a biological option for patients facing bypass surgery,” said lead author of the study Michael Simons, M.D., chief of the Section of Cardiology at Yale School of Medicine.

In the past, researchers used growth factors – proteins that stimulate the growth of cells – to grow new arteries, but this method was unsuccessful. Simons and his team studied mice and zebrafish to see if they could simulate arterial formation by switching on and off two signaling pathways – ERK1/2 and P13K.

“We found that there is a cross-talk between the two signaling pathways. One half of the signaling pathway inhibits the other. When we inhibit this mechanism, we are able to grow arteries,” said Simons. “Instead of using growth factors, we stopped the inhibitor mechanism by using a drug that targets a particular enzyme called P13-kinase inhibitor.”

“Because we’ve located this inhibitory pathway, it opens the possibility of developing a new class of medication to grow new arteries,” Simons added. “The next step is to test this finding in a human clinical trial.”

New Saint Louis University research has found that beta blockers, a class of drugs used to prevent the progression of heart failure and manage arrhythmias (irregular heart beat) and hypertension (high blood pressure), are underused in heart failure patients who receive implantable cardiac devices.

Failure to take beta blockers prior to implanting a cardiac device can affect the patient’s overall outcome and survival rate, says Paul Hauptman, M.D., SLUCare cardiologist and professor of internal medicine at Saint Louis University School of Medicine and lead author of the study.

Additionally, beta blocker use may eliminate the need for the cardiac device entirely by improving heart function. Multiple clinical practice guidelines, including those of the American College of Cardiology/American Heart Association, support the use of beta blockers.

The research, which was published in the March 2010 issue of Circulation: Cardiovascular Quality and Outcomes, used a large multi-state managed care database to examine the use of beta blockers both 90 days prior to and 180 days following the implantation of the device. When possible, researchers removed patients from the database who would not have qualified for beta blockers because of an underlying health issue, such as asthma, or because they received the device in an emergency situation.

Of the 2,766 patients included in the study, one third did not take beta blockers at any time in the 90 days before receiving a cardiac device. Additionally, less than 40 percent of the patients fell into the high use category, which was defined as having prescriptions for beta blockers that covered at least 80 percent of the 90 days prior to the procedure. The research found a modest increase of beta blocker use following the device procedure.

“Current guidelines for cardiac devices stress the importance of establishing optimal therapy, which includes the use of beta blockers, before considering a patient a candidate for the invasive procedure,” Hauptman said.

“Cardiac devices alone are not the answer. Implantable defibrillators in particular function as a safety net; they provide protection in the event the heart would stop beating. Beta blockers, on the other hand, are a therapy. They can prevent progression of heart failure.”

One of the criteria used to select candidates for cardiac devices is the ejection fraction, which refers to the fraction of blood pumped out of the heart with each heart beat. Beta blockers can improve a patient’s ejection fraction and decrease the risk of sudden death. In fact, in some cases, taking beta blockers can improve ejection fraction so greatly that the patient no longer needs a cardiac device, Hauptman says.

While the research shows that less than 40 percent of patients take beta blockers for the recommended 90 days prior to receive a cardiac device, what is less clear are the reasons behind the lack of adherence.

“It’s probably a combination of two factors: physicians are not prescribing the medication the way they should and patients may be non-compliant. From the proverbial 30,000 foot view, though, it doesn’t matter why,” Hauptman explained. “We need to have systems in place to ensure that patients are on optimal medical therapy prior to receiving a device.”

Hauptman says the issue comes down to improving patient care and managing health care cost.
“Implantable cardiac devices are invasive and very expensive. We have a great opportunity to improve the way we care for heart failure patients. Plus, we can save money along the way,” Hauptman said.

Over 60 per cent of Canadians are classified as overweight or obese. This epidemic is a concern for experts around the world. One of the major problems is high levels of lipids in the blood, which can lead to cardiovascular disease, fatty liver disease and Type 2 diabetes. But a University of Alberta researcher has taken a major step in protecting people against these diseases.

Richard Lehner and his research group found that decreasing the activity of an enzyme called triacylglycerol hydrolase, or TGH, in an animal model results in lowering the amount of fat in the blood and improves glucose metabolism. It also appears to keep fat from being deposited into organs that aren’t meant to store fat, like the liver.

A lack of TGH also showed to protect the beta cells in the pancreas that produce insulin and this can potentially protect from the development of diabetes in obese patients.

The benefits don’t end there. Animal models that lack the enzyme also showed to burn more fat and were more physically active compared to those who had the enzyme.

This discovery shows that TGH could eventually be used as a target for pharmaceuticals to combat metabolic complications associated with obesity.

“Nanoburrs” are nanoparticles coated with a sticky protein that makes them cling onto artery walls while they slowly release drugs: the US researchers who are developing them hope they will one day provide an alternative to drug-releasing stents in fighting heart disease.

The researchers, based at the Massachusetts Institute of Technology, (MIT) and Harvard Medical School, wrote about how they developed and tested the nanoburrs as potential drug-releasing agents for targeting and repairing damaged blood vessels in a paper that was published online on 19 January in the Proceedings of the National Academy of Sciences.

The nanoburrs can release their drug payload over several days, and could be used to deliver drugs to treat treat atherosclerosis and other inflammatory cardiovascular diseases, the researchers told the press.

They hope one day the nanoburrs can be used with vascular stents, the standard of care for most cases of clogged and damaged arteries, and in some cases may even replace stents in locations they are not well suited for, such as near a fork in the artery.

Co-author Omid Farokhzad, associate professor at Harvard Medical School, said that the nanoparticles are one of the first designed to home in precisely on damaged vascular tissue. He and co-author Robert Langer, a professor at MIT, have already developed nanoparticles that target and destroy tumors.

Langer said:

“This is a very exciting example of nanotechnology and cell targeting in action that I hope will have broad ramifications.”

The researchers designed the nanoburrs to target a specific structure in the artery wall, the basement membrane, which only becomes exposed when the walls are damaged.

In the study they used a drug called paclitaxel that inhibits cell division and helps prevent the growth of scar tissue that can clog arteries.

The nanoburrs are 60 nanometer-diameter spheres (the head of a pin is about 1 million nanometers), and comprise three layers: an inner core, a middle layer and an outer coating.

The inner core contains the drug payload and a polymer chain called PLA. The middle layer is made of a fatty material, soybean lecithin, and the outer coating is a polymer, PEG which protects the nanoburr as it travels through the bloodstream.

The drug release is controlled by varying the length of the PLA chain in the core: the longer the chain, the longer the duration of the release, which occurs through a reaction called ester hydrolysis whereby the drug becomes detached from the polymer.

To make the “burrs”, the researchers screened a library of short peptide sequences to find one that bound most effectively to molecules on the surface of the arterial basement membrane. They selected the most effective one, the seven-amino-acid sequenced C11, to coat the outer layer of the nanospheres.

Uday Kompella, professor of pharmaceutical sciences at the University of Colorado, who was not involved with the study, said the fact the targeted peptides are attached to an outer shell and not directly to the drug-carrying core, which would require a more complicated chemical reaction, could make it easier to manufacture the nanoburrs. He said this design also reduced the risk of bursting and releasing the drug too soon.

The researchers said they have managed to achieve drug release periods lasting 12 days in cultured cells.

They also injected the nanoburrs intravenously into the tails of rats and showed they reached their intended target: the damaged walls of the left carotid artery (the vessel that supplies the head and neck with oxygenated blood). They found that the nanoburrs bound to the damaged walls at twice the rate of non-targeting particles.

The authors wrote that:

“The nanoparticles inhibited human aortic smooth muscle cell proliferation in vitro and showed greater in vivo vascular retention during percutaneous angioplasty over nontargeted controls.”

Lead author Juliana Chan, a graduate student in Langer’s lab at MIT, said that if introavenously injectable particles that deliver drugs over a longer period were available, patients wouldn’t have to undergo repeated and invasive injections directly into the affected area.

Mark Davis, professor of chemical engineering at Caltech, and who was not involved in the study, told the press that this work is a promising step toward developing new treatments for cardiovascular and other diseases:

“If they could do this in patients — target particles to injured areas — that could open up all kinds of new opportunities,” said Davis.

A growing body of research continues to warn of the potential long-term effects of radiation exposure for patients and medical providers during such imaging procedures as x-rays and computed tomography (CT) scans, both of which are traditionally used with certain heart procedures.

Now researchers at the University of Virginia Health System have developed a promising x-ray free technique to treat a common heart disorder called atrial fibrillation – a breakthrough that could all but eliminate radiation exposure to patients and their medical providers.

“One of the most exciting things about our research is the direct impact on patient care and safety,” says John D. Ferguson, MD, associate professor of cardiology in the UVA School of Medicine. The study, led by Ferguson, appears in the December 2009 issue of Circulation. “Cardiac interventions continue to evolve toward lower risk procedures, and this study is another huge step in that direction.”

More than two million Americans suffer from atrial fibrillation (AF), a condition characterized by an irregular heart rate that can lead to weakness, blood clotting and even stroke.

In order to regulate the heart’s rhythm, physicians commonly perform a catheter ablation – a procedure in which doctors use x-ray fluoroscopy to guide a catheter, or flexible tube, to the affected area of the heart. The procedure typically lasts three to four hours, leaving patients and medical providers exposed to significant radiation.

But Ferguson’s research team has developed and successfully tested a new technique to perform catheter ablation of AF using an ultrasound catheter (intracardiac echocardiography) and electroanatomic mapping without the use of x-ray fluoroscopy for the entire procedure.

Using an ultrasound catheter within the heart, physicians can obtain high resolution images of the heart and other key anatomic structures. This provides complete visualization at all times of the catheter’s location, allowing physicians to steer the tube to affected target areas while avoiding injury to key cardiac structures.

The novel technique also uses a computer mapping system, which displays in 3D the image of the heart and the catheter’s location and allows physicians to record precise location points along the catheter’s path.

And to further eliminate radiation exposure in AF patients, the new technique uses cardiac MRI instead of CT scans for all required imaging prior to the procedure. Researchers performed the novel technique in a pilot study on 21 consecutive patients referred to the UVA Atrial Fibrillation Center.

“Larger studies are needed to confirm the safety of the procedure, but the concept that you can perform complex electrophysiology procedures without any use of x-ray is outstanding,” says Brian Annex, MD, chief of the UVA Division of Cardiology.

“This research is a ground-breaking step in our efforts to minimize radiation exposure to all patients. This is a major goal that is especially critical to those most vulnerable — patients who would otherwise require excessive radiation due to weight, women of child bearing potential, and of course children and younger adults,” Annex says.

“This procedure is currently being used in selected patients at UVA Medical Center while ongoing investigations are underway to establish the full spectrum of patients who we hope can receive this type of approach in the near future.”

An article Online First and in an upcoming edition of The Lancet reports the new analysis of the PLATO trial (PLATelet inhibition and patient Outcomes). New research shows that the stronger anticlotting medication tricagrelor reduces death rates without increasing bleeding compared with the current standard treatment of clopidogrel for heart attack patients. The article is the work of Dr Christopher P Cannon, TIMI Study Group, Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA, USA, and colleagues.

Dr Cannon explains: “Heart attacks are caused by blood clots in the heart artery. We see today that using a stronger anticlotting drug lowered the chance of having a second heart attack – and reduced the risk of dying from one. This is a key advance for heart attack patients.” An associated note qualifies the introduction of ticagrelor as ‘a landmark event that should redefine the care of patients with acute coronary syndromes’.

Clopidogrel is an antiplatelet drug. It is used in combination with aspirin in patients with acute coronary syndrome (heart attack/unstable angina). It prevents clots forming and reduces the risk of further heart attacks, stroke, and death. Ticagrelor has a superior and more consistent antiplatelet effect than does clopidogrel. In addition, it has a faster onset and offset of action. The authors compared in this study the two drugs in patients with acute coronary syndromes who were planned to undergo invasive procedures. Those procedures included angioplasty and stenting of the coronary artery.

Of a total of 18,624 patients hospitalised for acute coronary syndromes, an invasive strategy was planned at the beginning of the study for 13,408 (72 percent). Randomly, patients were assigned in a one-to-one ratio to ticagrelor and placebo (180 mg loading dose followed by 90 mg twice a day), or to clopidogrel and placebo (300 – 600 mg loading dose or continuation with maintenance dose followed by 75 mg per day) for six to twelve months. All patients were given aspirin. The primary endpoint was any of cardiovascular death, myocardial infarction, or stroke.

Results indicated that patients in the ticagrelor group were 16 percent less likely to experience the primary endpoint than those in the clopidogrel group. The endpoint of cardiovascular death, heart attack, or stroke occurred in fewer patients in the ticagrelor group than in the clopidogrel group (event rate at 360 days 9.0 percent compared to 10.7 percent). Furthermore, the risk of death was considerably reduced from 5.0 percent (clopidogrel) to 3.9 percent (ticagrelor). There was a reduction in the risk of dying over one year of around one fifth. Blood clots developing inside heart stents were also significantly reduced. On the other hand, there was no statistically significant disparity between clopidogrel and ticagrelor groups in the rates of total major bleeding (12 percent each group), or severe bleeding (3 percent both groups).

The authors comment: “Patients given ticagrelor had significant and clinically relevant reductions in cardiovascular and total deaths, myocardial infarction, and stent thrombosis, without an increase in risk of major bleeding. The benefits with respect to clinical events and stent thrombosis were consistent whether or not patients were given standard or higher loading doses of clopidogrel, as advocated for patients undergoing invasive strategies.Thereby, ticagrelor has important advantages, and improves the early invasive and long-term management of patients with acute coronary syndromes.”

They say in conclusion: “We estimate that use of ticagrelor instead of clopidogrel for 1 year in 1,000 patients with acute coronary syndromes and who are planned to undergo an invasive strategy at the start of drug treatment would lead to 11 fewer deaths, 13 fewer myocardial infarctions, and six fewer cases of stent thrombosis without an increase in the rates of major bleeding or transfusion.”

In an associated comment, Dr Gregg W Stone, Columbia University Medical Center, Cardiovascular Research Foundation, New York, USA, remarks: “These compelling results support ticagrelor as a new standard of care in acute coronary syndromes. However, a personalised approach to drug selection should be used wherein each patient’s individualised risk of ischaemia versus bleeding is considered. Clopidogrel might still be appropriate for selected patients who are at relatively low risk of myocardial infarction or stent thrombosis and/or high risk of major bleeding, and/or for whom non-compliance with ticagrelor because of cost or other considerations (eg, twice daily dosing) is a concern. Nonetheless, the introduction of ticagrelor, a more potent and effective agent which is as safe as its predecessor, is a landmark event that should redefine the care of patients with acute coronary syndromes.”

“Comparison of ticagrelor with clopidogrel in patients with a planned invasive strategy for acute coronary syndromes (PLATO): a randomised double-blind study”

The cardiovascular risk that is associated with proteinuria, or high levels of protein in the urine, a common test used by doctors as an indicator of increased risk for progressive kidney disease, heart attack and stroke, has race-dependent effects, according to a new study by researchers at Wake Forest University School of Medicine.

The study appears in the January issue of Diabetes Care.

“Proteinuria, a long accepted indicator of heart disease risk, has far less impact on blacks than it does on whites,” said Barry Freedman, M.D., John H. Felts III Professor, chief of the Section on Nephrology, and lead researcher on the study. “In the medical community, it is believed that the more protein in a patient’s urine, the greater the risk for heart disease and stroke, and this is true – in white populations. Our study indicates that excess protein in the urine – a common finding with progressive kidney disease in individuals with diabetes – is strongly associated with calcium deposition in the major arteries in white patients, but not in black patients. Therefore, proteinuria appears to be associated with an increased risk of heart attack in the white ethnic group. There may be biologic factors predisposing whites to heart disease or protecting blacks from developing it.”

In the general community, blacks have more heart disease risk factors than whites, including higher blood pressures and LDL (known as “bad”) cholesterol levels, and higher blood sugars in patients with diabetes, Freedman explained. As such, they face a higher risk for heart attack than whites, he said.

However, several large studies have shown that despite having more risk factors for hardening of the arteries, black men had less calcium in the heart arteries – one-eighth the amount – compared to white men. In addition, given access to equivalent healthcare as whites, blacks with diabetes face only half the risk of a heart attack, indicating that blacks appear to somehow be protected from the cardiovascular effects of these risk factors, Freedman said.

In this study, Freedman and colleagues investigated whether biologic factors protect blacks from heart disease, particularly those with diabetes. They evaluated whether excess protein excretion in the urine – a major heart disease risk factor in whites – was also a risk factor for heart and vascular disease in blacks. The level of urine protein was examined in 835 white participants and 393 black participants, all with diabetes. Participants were also tested for atherosclerosis, based on the buildup of calcium in their major arteries.

The research team found that in the white population, greater amounts of protein in the urine were directly associated with higher levels of atherosclerosis. This association, however, was not seen in the black study population.

“It turns out that urinary protein, an accepted predictor of calcium buildup and risk factor for heart attack that we have long relied upon, is a much stronger indicator in whites than blacks,” Freedman said. This finding is important, Freedman added, because blacks with diabetes and kidney failure tend to live significantly longer after starting kidney replacement therapy (dialysis) and suffer fewer heart attacks, compared to whites.

“The vast majority of patients who develop kidney disease and start dialysis have leaked protein into their urine for many years,” Freedman said. “But black patients generally live longer on dialysis, despite having more risk factors – including more protein in the urine – and typically being seen by kidney specialists later in the course of the disease, than their white peers.”

The findings present the first report demonstrating that there are ethnic differences in the effect of the accepted cardiovascular disease risk factor “protein in the urine” on development of atherosclerosis. The researchers further propose that there may be inherited factors in whites that contribute to higher risk for vascular disease and heart attack, or protective inherited factors in blacks.

Research published today on bmj.com reports that angiotensin receptor blockers are associated with a reduced risk of Alzheimer’s disease and dementia. These drugs are normally used to treat high blood pressure and heart disease.

In addition, the study concludes that angiotensin receptor blockers appear to offer greater protection against Alzheimer’s disease and dementia than other high blood pressure and heart disease medication.

A growing number of people are threatened by dementia (including Alzheimer’s disease) as they get older. This has important economic implications since individuals who suffer from either disease can spend long periods of time in nursing homes.

Dementia and Alzheimer’s disease are complex diseases. There is increasing evidence of three main risk factors:

• age
• genetics
• heart disease

Mid-life diseases particularly like diabetes and high blood pressure seem to be associated with a higher chance of developing dementia.

Researchers explain that this is the first large scale study to investigate whether angiotensin receptor blockers reduce the risk of developing dementia and Alzheimer’s disease.

Professor Benjamin Wolozin from Boston University School of Medicine led the team of researchers. They investigated the incidence of dementia in over 800,000 individuals in the US from 2002 to 2006. They were mostly (98 percent) male subjects. The participants had cardiovascular disease and were 65 years of age or older.

The research subjects were divided in three groups: one using angiotensin receptor blockers, another the blood pressure lowering drug lisinopril and the third using other comparative drugs used for heart disease.

The findings indicate that the group on angiotensin receptor blockers was significantly less likely to develop Alzheimer’s disease or dementia. In addition, they reveal that angiotensin receptor blockers have an additive effect when used in combination with another type of high blood pressure drug (ACE inhibitors). In fact, individuals with existing Alzheimer’s disease or dementia who took both medicines were less likely to die early or be admitted to nursing homes.

In conclusion, Wolozin comments that the research is significant because it is the “first to compare both risk of dementia and progression of dementia in users of angiotensin receptor blockers compared with users of a drug from the same class (lisinopril) or users of other drugs prescribed for cardiovascular disease.”

In an associated editorial, two senior doctors from the University of Calgary highlight that the public health implications of finding an effective way of preventing dementia are immense. They say in closing that however, further work is needed to verify the usefulness of antihypertensives in general and angiotensin receptor blockers in particular.

“Use of angiotensin receptor blockers and risk of dementia in a predominantly male population: prospective cohort analysis”

A new approach to common cardiac procedures called transradial angiography might lead to reduced patient complications and recovery time and decreased hospital costs.

Cardiologists at the University of Illinois and Jesse Brown VA medical centers are among the first in the Chicago area to offer the approach to heart angiograms and clearing blocked arteries.

In the procedure, a catheter is threaded through the small radial artery in the wrist rather than the larger femoral artery in the groin.

“It’s a simple change that has a dramatic impact on the experience and recovery of the patient,” said Dr. Adhir Shroff, assistant professor of cardiology at UIC.

Although complications from standard catheterization through the groin are low, occurring in only 2 percent to 9 percent of patients, the transradial approach can reduce bleeding — the most common complication, particularly among women and the elderly — to under 1 percent. It also eliminates much of the discomfort associated with the procedure.

Following a standard angiogram and angioplasty through the femoral artery, the patient needs to lie still on his or her back for four to six hours. This can be very uncomfortable for elderly patients with back problems, Shroff said. Walking can be uncomfortable for days.

In contrast, patients who have the procedure done via the wrist can immediately sit up, eat, and walk without pain, said Shroff.

The transradial procedure has been widely adopted in Europe, where up to 60 percent of procedures are now done this way. In the U.S., only about 2 percent of coronary interventions use the procedure.

“The issue is really just the learning-curve,” said Shroff. “The change requires dozens of small changes — everything from redesigning the sterile drape so that the openings are at the wrist rather than the leg and finding smaller needles, wires and catheters to the way the table is set up.”

Last month, Shroff, Dr. Mladen Vidovich, UIC assistant professor of cardiology, and Bernadette Speiser, nurse manager in cardiology at the Jesse Brown VA Medical Center, led an all-day workshop at UIC in implementing a transradial approach that drew cardiologists and other catheter lab team members from the Chicago area and around the country. The Jesse Brown VA Medical Center is one of only a handful of VA centers in the country to offer the procedure.

“We’ve solved dozens of small problems that stand in the way of implementing this kind of program, so that everyone interested in transradial cardiac catheterization doesn’t have to re-invent the wheel,” said Speiser.

In addition to offering a ready-made approach to the technique, Shroff said the key is enlisting the help and cooperation of everyone involved in the cath lab, from nurses and nurse-managers to the technicians who set up the equipment.

Schroff says there is no downside to using the transradial approach where appropriate.

“And in these times, as everyone tries to think strategically about the delivery of healthcare, the savings in terms of costs and hospital resources offered by transradial catheterization make it especially attractive,” he said. “It is my belief that once a patient has their procedure done from the wrist, they will demand that approach in the future, if they require it again.

Vitamin-fortified foods and dietary health supplements can ease health worries. But what kinds of vitamins are right for you? And how much of them should you take, and how often?

A research group from Tel Aviv University has done the most comprehensive and accurate study of clinical data on Vitamin E use and heart disease to date, and it warns that indiscriminate use of high-dose Vitamin E supplementation does more harm than good. Their results were recently reported in ATVB, a leading journal of cardiology, and discussed in the journal BioFactors.

“There were so many conflicting reports about Vitamin E and its effect on various diseases, particularly heart disease, that we wanted to set the record straight, says Prof. Dov Lichtenberg of TAU’s Sackler School of Medicine.

“Our new study shows that some people may be harmed by the treatment, whereas others may benefit from it. Now we’re trying to identify groups of people that are most likely to benefit from the effects of Vitamin E,” adds study co-researcher Dr. Ilya Pinchuk. The TAU research team also included decision analyst Dr. Moshe Leshno of the Sackler Faculty of Medicine and the Leon Recanati Faculty of Management and Dr. Yedidya (Didi) Dotan, whose PhD thesis is the basis for this analysis.

A longer life without it?

Applying a very different approach than any previous study, the team of researchers put their heads together to draw definitive conclusions about Vitamin E. In their publication in ATVB the Tel Aviv University researchers evaluated the results of the prominent studies measuring the health benefits of Vitamin E but reached varying conclusions. There have been many previous publications on the subject. Analysis of the results of all these past publications together revealed that subjects who did not take a Vitamin E supplement enjoyed more quality-adjusted-life-years (QALY), a standard parameter used in medicine to assess the effect of medical interventions.

“To explain the meaning of this parameter,” says Dr. Pinchuk, “consider a participant who was healthy during the first 10 out of 20 years of the study, but then suffered a stroke and became dependent on others throughout the following 10 years. The QALY during the first 10 years of healthy life is 10, but after the stroke the quality of life is only half of what this person had before. Therefore, the second decade is considered the equivalent of merely 5 years of healthy life and in sum a person’s QALY is 15.

The researchers examined data from more than 300,000 subjects in the US, Europe and Israel. “Our major finding,” says Dr. Pinchuk, “was that the average quality-adjusted life years (QALY) of Vitamin E-supplemented individuals was 0.30 less than that of untreated people. This, of course, does not mean that everybody consuming Vitamin E shortens their life by almost 4 months. But on average, the quality-adjusted longevity is lower for vitamin-treated people. This says something significant.”

Overturning earlier studies

In the BioFactors article, the TAU researchers defined “the real challenge as being able to identify who is likely to benefit taking Vitamin E.” They also explored the first hypothesis of the oxidative theory of atherosclerosis published more than 20 years ago, which was the basis for the widespread use of antioxidants today. At first, this hypothesis raised great enthusiasm that anti-oxidants like Vitamins E and C and flavonoids could be used to prevent disease or its progression. In this respect, the new findings are very disappointing.

“We’ve now concluded that going to the grocery or to a health food store to buy Vitamin E supplements, for the most part, won’t do you good. In some cases it can do harm,” says Dr. Pinchuk. “A doctor wouldn’t prescribe anti-hypertension drugs to the whole population, only to those with low blood pressure. It seems this is true for antioxidants, too. When you give them to everybody, you may be doing more harm than good. Some people may benefit from it, but more may be harmed.”

The researchers are now building sets of criteria that detail under what conditions Vitamin E supplements should be taken. They are also investigating the chemical mechanisms of antioxidants in general to better understand how they work.