2009, Number 1
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Rev Med Inst Mex Seguro Soc 2009; 47 (1)
Use of Antioxidants in Prevention of the Cardiovascular Disease: Meta-analysis of Clinical Trials
García-Álvarez JL, Sánchez-Tovar M, García-Vigil JL
Language: Spanish
References: 56
Page: 7-16
PDF size: 345.02 Kb.
ABSTRACT
Objective: to evaluate if used of medication with antioxidants, antiplatelets, statins and modulators of inflammation reduces effectively the risk of presenting a cardiovascular disease (CVD).
Methods: a search on clinical trials (randomized, double blind and controlled clinical studies) in which the use of antioxidants, antiplatelets, statins and modulators of inflammation were investigated for the primary and secondary prevention of CVD. The selected studies were analyzed by a systematic revision, applying the meta-analysis.
Results: 20 studies were included. In the subgroup of vitamin
E 3623 events of the non fatal acute myocardial infarction (AMI) appeared, RR = 1 (0.93-1.06) IC 95 %,
p = 0.01. In the subgroup of statins 2795 events of non fatal acute myocardial infarction (AMI) appeared, RR = 0.68 (0.63-0.73) IC 95 %,
p = 0.02. In the subgroup of antiplatelets 1199 events of non fatal AMI appeared, RR = 0. 91 (0.81-1.02) IC 95 %,
p = 0.42. In the subgroup of ω-3 fatty acids 434 events of the non fatal AMI appeared, RR = 0.93 (0.76-1.13) IC 95 %, p = 0.002.
Conclusions: vitamin E did not show any benefit, in comparison with the antiplatelets, statins, and ω-3 fatty acids.
REFERENCES
Sánchez-Rodríguez M, Santiago-Osorio E, Vargas L. Propuesta de un constructo para evaluar integralmente el estrés oxidativo. Bioquimica 2004;29(3):81-90.
Nakamura H. Experimental and clinical aspects of oxidative stress a redox regulation. Rinsho Byori 2003;51(2):109-114.
Park J, Ryo J, Jin LH, Bahn JH, Kim JA, Yoon CS, et al. 9-polylysine protein transduction domain: enhaced penetration efficiency of superoxide dismutase into mammalian cell and skin. Mol Cells 2002;13(2):202-208.
Griendling K, FitzGerald G. Oxidative stress and cardiovascular injury: Part I: basic mechanisms and in vivo monitoring of ROS. Circulation 2003; 108(16):1912-1916.
Griendling K, FitzGerald G. Oxidative stress and cardiovascular injury: Part II: animal and human studies. Circulation 2003;108(17):2034-2040.
Butler RN, Fossel M, Pan CX, Rothman DJ, Rothman SM. Anti-aging medicine. Efficacy and safety of hormones an antioxidants. Geriatrics 2000;55(7):55-58.
Olguín-Contreras G, Meléndez-Mier G, Zúñiga RA, Pasquetti-Ceccatelli AP. Antioxidantes y aterosclerosis. Rev Endocrinol Nutr 2004;12(4): 199-206.
Fichtischerer S, Breuer S, Schächinges V, Dimmeler S, Zeiher AM. C reactive protein levels determine systemic nitric oxide bioavailability in patients with coronary artery disease. Eur Heart J 2004;25(16):1412-1418.
Schröder H, Maurrugat J, Covas M, Elosua R, Pena A, Weinbrenner T, et al. Population dietary habits and physical activity modification with age. Eur J Clin Nutr 2004;58(2):302-311.
Schwedhelm E, Maas R, Troost R, Böger R. Clinical Pharmacokinetics of antioxidants and their impact on systemic oxidative stress. Clin Pharmacokinet 2003;42(5):437-459.
Eidelman RS, Hollar D, Hebert PR, Lamas GA, Hennekens CH. Randomized trial of vitamin E in the treatment and prevention of cardiovascular disease. Arch Intern Med 2004;164(14):1552-1556.
Polla BS. Therapy by taking away: the case of iron. Biochem Pharmacol 1999;57(12):1345-1349.
García-Vigil JL. La importancia de los oligoelementos en el paciente con insuficiencia renal. Nutricion Clinica 2003;6(3):283-290.
Schmidt E, Arnesen H, De Caterina R, Ramussen L, Kristensen S. Marine ω-3 polyunsaturated fatty acids and coronary heart disease. Part I. Background, epidemiology, animal data, effect on risk factors and safety. Thromb Res 2005;115(3):163-170.
He K, Song Y, Daviglus M, Liu K, Van Horn L, Dyer AR, et al. Fish consumption and incidence of stroke. A Meta-analysis of cohort studies. Stroke 2004;35(7):1538-1542.
Kritharides L, Stocker R. The use of antioxidant supplements in coronary heart disease. Atherosclerosis 2002;164(2):211-219.
Tomasian D, Keaney JF, Vita JA. Antioxidants and the bioactivity of endotheliumderived nitric oxide. Cardiovasc Res 2000;(47):426-435.
Laight DW, Carrier MJ, Anggard EE. Antioxidants, diabetes and endothelial dysfunction. Cardiovasc Res 2000;(47):457-464.
Gotto AM, DPHIL, FACC. Antioxidants, statins, and atherosclerosis. J Am Coll Cardiol 2003.41(7): 1205-1210.
Rosenson R. Statins in atheroesclerosis: lipid lowering agent with antioxidants capabilities. Atherosclerosis 2004;173(1):1-12.
Von Schacky C. n-3 fatty acids and the prevention of coronary atherosclerosis. Am J Clin Nutr 2000;71(1 Suppl):224S-227S.
Stone NJ. Fish consumption, fish oil, lipids, and coronary heart disease. Circulation 1996;94(9):2337-2340.
Guyatt GH, Sackett DL. Users’ guides to the medical literature: II. How to use an article about therapy or prevention. JAMA 1992;270:2598-2601.
Evidence-Based Medicine Working Group. Evidence Based Medicine: A New Approach to Teaching the Practice of Medicine. JAMA 1992;268(17):2420-2425.
Lazcano-Ponce E, Salazar-Martínez E, Gutiérrez-Castrellón P, Ángeles-Llerenas A, Hernández-Garduño A, Viramontes JL. Ensayos clínicos aleatorizados: variantes, métodos de aleatorización, análisis, consideraciones éticas y regulación. Salud Publica Mex 2004;46(6):559-584.
Dickensin K. Systematic reviews in epidemiology: why are we so far behind. Int J Epidemiol 2002;31(1):6-12.
Petticrew M. Why certain systematic reviews reach uncertain conclusions. BMJ 2003;326;756-758.
Hernández-Ávila M, Garrido F, Salazar-Martínez E. Sesgos en estudios epidemiológicos. Salud Publica Mex 2000;42(5):438-446.
Tôrnwall ME, Virtamo J, Korhonen PA, Virtanen MJ, Taylor PR, Albanes D, et al. Effect of a-tocopherol and b-carotene supplementation on coronary heart disease during the 6-year post-trial follow-up in the ATBC study. Eur Heart J 2004;25 (13):1171-1178.
Stephens NG, Parsons A, Schofield PM, Kelly F, Cheeseman K, Mitchinson MJ, et al. Randomised controlled trial of vitamin E in patients with coronary disease: Cambridge Heart Antioxidant Study (CHAOS). Lancet 1996;347(9004):781-786.
GISSI-Prevenzione Investigators. Dietary supplementation with ω-3 polyunsatured fatty acids and vitamin E after myocardial infarction: results of the GISSI-Prevenzione trial. Lancet 1999(9177);354:447-55.
The Heart Outcomes Prevention Evaluation Study Investigators. Vitamin E supplementation and cardiovascular events in high risk patients. N Engl J Med 2000;342(3):154-160.
Heart Protection Study Collaborative Group. MRC/BHF Heart Protection Study of antioxidant vitamin supplementation in 20536 high risk individuals: a randomised placebo-controlled trial. Lancet 2002;360(9326):23-33.
Collaborative-Group of the Primary Prevention Project (PPP). Low-dose aspirin and vitamin E in people at cardiovascular risk: a randomised trial in general practice. Lancet 2001;357(9250):89-95.
Boaz M, Smetana S, Weinstein T, Matas Z, Gafter U, Laina A, et al. Secondary prevention with antioxidants of cardiovascular disease in end stage renal disease (SPACE): randomised placebo-controlled trial. Lancet 2000;356 (9237):1213-1218.
Hercberg S, Galán P, Preziosi P, Bertrais S, Mennen L, Malvy D, et al. The SUVIMAX Study. A randomized, placebo-controlled trial of the health effects of antioxidant vitamins and minerals. Arch Intern Med 2004;164(21):2335-2342.
Lee I, Cook N, Gaziano JM, Gordon D, Ridker PM, Manson JE, et al. Vitamin E in the primary prevention of cardiovascular disease and cancer. The Women’s Health Study: a randomized controlled trial. JAMA 2005;294(1):56-65.
Tonelli M, Moyé L, Sacks FM, Kiberd B, Curhan G. Pravastatin for secondary prevention of cardiovascular events in persons with mild chronic renal insufficiency. Ann Intern Med 2003;138(2):98-104.
Heart Protection Study Collaborative Group. MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20536 high-risk individuals: a randomised placebo-controlled trial. Lancet 2002;360(9326):7-22.
The Long-Term Intervention With Pravastatin in Ischaemic Disease (LIPID) Study Group. Prevention of cardiovascular events and death with pravastatin in patients with coronary heart disease and a broad range of initial cholesterol levels. N Engl J Med 1998;339(19):1349-1357.
Shepherd J, Blauw GJ, Murphy MB, Bollen E, Buckley BM, Cobbe SM, et al. Pravastatin in elderly individuals at risk of vascular disease (PROSPER): a randomised controlled trial. Lancet 2002;360(9346):1623-1630.
Scandinavian Simvastatin Survival Study Group. Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S). Lancet 1994;344(8934):1383-1389.
CAPRIE Steering Committee. A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). Lancet 1996;348(9038):1329-1339.
Bhatt DL, Fox KA, Hacke W, Berger PB, Black HR, Boden WE, et al. Clopidogrel and aspirin versus alone for the prevention of atherotrombotic events (CHARISMA). N Engl J Med 2006;354 (16):1706-1717.
Ridker PM, Cook NR, Lee IM, Gordon D, Gaziano JM, Manson JE, et al. A randomised trial of low dose aspirin in the primary prevention of cardiovascular disease in women. N Engl J Med 2005;352(13):1293-1304.
Burr ML, Fehily AM, Gilbert JF, Rogers S, Holliday RM, Sweetman PM, et al. Effects of changes in fat, fish, and fibre intakes on death and myocardial reinfarction: Diet and Reinfarction Trial (DART). Lancet 1989;2(8666):757-61.
Lorgeril M, Renaud S, Marmelle N, Selen P, Martin JL, Monajaud I, et al. Mediterranean alpha-linolenic acid-rich diet in secondary prevention of coronary heart disease. Lancet 1994;343(8911):1454-1159.
Singh RB, Niaz MA, Sharma JP, Kumar R, Rastogi V, Moshiri Ml. Randomised, double-blind, placebocontrolled trial of fish oil and mustard oil in patients with suspected acute myocardial infarction: the Indian experiment of infarct survival. Cardiovasc Drugs Ther 1997;11(3):485-1491.
Physicians Health Study Research Group. Final report on the aspirin component of the ongoing Physicians’ Health Study. Steering Committee of the Physicians’ Health Study Research Group. N Engl J Med 1989;321(3):129-135.
He K, Rimm EB, Merchant A, Rosner BA, Stampfer MJ, Willett WC, et al. Fish Consumption and Risk of Stroke in Men. JAMA 2002;288(24):3130-3136.
Iso H, Rexrode KM, Stampfer MJ, Manson JE, Colditz GA, Speizer FE, et al. Intake of fish and omega-3 fatty acids and risk of stroke in women. JAMA 2001;285(3):304-312.
Erkkilä AT, Lehto S, Pyörälä K, Uusitupa MI. ω-3 fatty acids and 5-y risk of death and cardiovascular disease events in patients with coronary artery disease. Am J Clin Nutr 2003;78 (1):65-71.
Lemaitre RN, King IB, Mozaffarian D, Kuller LH, Tracy RP, Siscovick DS. ω-3 polyunsatured fatty acids, fatal ischaemic heart disease, and nonfatal myocardial infarction in older adults; the Cardiovascular Health Study. Am J Clin Nutr 2003;77(2):319-325.
Bucher HC, Hengstler P, Schindler C, Meier G. ω-3 polyunsaturated fatty acids in coronary heart disease: a meta-analysis of randomized controlled trials. Am J Med 2002;112(4):298-304.
Lee KW, Lip GY. The role of omega-3 fatty acids in the secondary prevention of cardiovascular disease. Q J Med 2003;96(7):465-480.
Von Schacky C, Angerer P, Kothny W, Theisen K, Mudra H. The Effect of dietary ω-3 fatty acids on coronary atherosclerosis: a randomized, doubleblind, placebo-controlled trial. Ann Intern Med 1999;130(7):554-562.