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Q
Antioxidants: Bad for Cholesterol?

I've read that antioxidants combined with the anti-cholesterol drug Lipitor can increase the risk of heart attack and stroke. Is this true? I take 400-1,000 mg of vitamin C and 400 IU of vitamin E daily plus 10 mg of Lipitor.

A
Answer (Published 8/7/2002)

(Reviewed on 1/24/2005)

You probably read about a report published in 2001 in the Journal of the American Heart Association. Researchers at the University of Washington, Seattle, found that the combination of antioxidant vitamin supplements and cholesterol-lowering "statin" drugs (which include Lipitor) resulted in a smaller increase in HDL ("good") cholesterol than was found when the drugs were used alone. In fact, the results showed no increase in HDL(2), the component of HDL that is considered responsible for most of the heart-protective effects.

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The results suggest that the antioxidants - a combination of vitamins E and C, beta-carotene and selenium - interfered with the drugs' ability to raise HDL. An editorial accompanying this study cautioned physicians to tell patients not to take antioxidant supplements to prevent or treat coronary artery disease, especially in combination with drugs to lower cholesterol.

To my knowledge, no study has shown that taking antioxidants actually results in more heart attacks or strokes, but the findings of this particular study are disturbing. To better assess their significance, I consulted my colleague, Dr. Joseph Alpert, a cardiologist and chief of medicine here at the University of Arizona in Tucson. Dr. Alpert explained that the study described above was very small (only 153 patients participated) and that larger studies including thousands of patients showed no adverse effects of taking both cholesterol-lowering statin drugs and antioxidants. He also noted that, unfortunately, the larger studies showed no advantage to the heart as a result of taking antioxidants and said that it remains to be proven whether the vitamins, taken over a long time are beneficial to the cardiovascular system.

I agree with Dr. Alpert that we need more evidence from more studies to fully understand the effect of antioxidants on heart disease among patients who already taking drugs to lower their risk.

We do know that antioxidants have many beneficial effects elsewhere in the body - they boost immunity, enhance musculoskeletal and skin integrity, and protect DNA from damage. I think it is okay to continue taking your antioxidants (I would add mixed carotenoids and selenium.) Be sure to ask the doctor who prescribed the Lipitor to monitor your lipid levels to make sure the drug is having the desired effect.

Andrew Weil, M.D.

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