Vitamins for Cardiovascular Diseases: Is the Expense Justified?

Despite the knowledge that a well-balanced diet provides most of the nutritional requirements, the use of supplemental vitamins is widespread among adults in the United States. Evidence from large randomized controlled trials over the last 2 decades does not support vitamin supplementation for the reduction of cardiovascular risk factors or clinical outcomes. Many of the vitamins used in common practice likely are safe when consumed in small doses, but long-term consumption of megadoses is not only expensive but has the potential to cause adverse effects. Therefore, a need exists to revisit this issue, reminding the public and healthcare providers about the data supporting the use of vitamins for cardiovascular disease, and the potential for harm and the expense associated with their unnecessary use. In this review, we highlight the scientific evidence from randomized controlled studies regarding the efficacy and safety of vitamin supplementation for primary and secondary prevention of cardiovascular diseases and outcomes. We also draw attention to issues related to widespread and indiscriminate use of vitamin supplements and the need to educate the public to curtail unnecessary consumption and expense by limiting their use based on strong scientific evidence.

Chelation therapy in cardiovascular disease: an update.

INTRODUCTION: The off-label use of chelation therapy (disodium edetate or EDTA) for prevention of cardiovascular disease (CVD) is widespread, despite the lack of convincing evidence for efficacy or approval from the Food and Drug Administration. After the publication of results from the National Institute of Health-sponsored Trial to Assess Chelation Therapy (TACT), a randomized controlled trial (RCT) in patients after myocardial infarction (MI), there is a renewed interest in clarifying the role of this treatment modality for patients with coronary artery disease. Areas covered: This narrative review highlights the evidence from observational studies and RCT in assessing the effect of chelation therapy on cardiovascular outcomes and potential for adverse effects or harm. Expert commentary: Although encouraging results were reported in TACT, the evidence is insufficient to recommend the routine use of chelation therapy even in the post-MI diabetic subgroup, which appeared to benefit. The ongoing TACT2 trial may clarify its use in post-MI diabetic patients. Unsubstantiated claims of chelation therapy as an effective treatment of atherosclerosis should be avoided and patients made aware of the inadequate evidence for efficacy and potential adverse effects, especially the harm that can occur if used as a substitute for proven therapies.

Safety, acceptance, and physiologic effects of sauna bathing in people with chronic heart failure: a pilot report.

OBJECTIVES: To perform a pilot study and make a preliminary assessment of the safety and acceptance of supervised sauna bathing at moderate temperatures in people with chronic heart failure (CHF). Secondary measures included its impact on exercise tolerance and neuroendocrine concentrations. DESIGN: Randomized, controlled, cross-over trial. SETTING: Physical medicine and rehabilitation clinic. PARTICIPANTS: Six men and 3 women (age, 62-87y) with New York Heart Association Class III and IV CHF. INTERVENTIONS: Subjects were randomized into 2 groups and told to maintain their normal medication and activity regimens. One group then began a 3-times-a-week, 4-week sauna bathing program at 60+/-1 degrees C while the other continued with their usual activities and medications. Assignments were then reversed. Sessions were 15 minutes in length but were prolonged an additional 5 minutes for oral temperature increases less than 1.0 degrees C. MAIN OUTCOME MEASURES: Patient acceptance, Minnesota Living With Heart Failure Questionnaire (MLWHFQ) scores; treadmill exercise duration and plasma adrenaline, noradrenalin, aldosterone, atrial naturectic factor, adrenomedulin, and endothelin. RESULTS: Sauna bathing was well tolerated and no adverse effects were reported. Improvements in MLWHFQ scores and treadmill endurance did not achieve statistical significance on a between-group basis but were more marked after the sauna than during the control phase. Neuroendocrine concentrations showed no clear effect of sauna treatment with a between-group statistically significant difference (P=.049) found only in the case of noradrenalin's 24% decrease. CONCLUSIONS: Sauna bathing under the moderate and supervised conditions of this study appears to be well tolerated and may be safe for people with CHF. More research is needed to further evaluate the safety and potential benefits of this approach.

Evaluation and clinical implications of aortic valve calcification measured by electron-beam computed tomography.

BACKGROUND: Electron-beam computed tomography (EBCT) is used to measure coronary calcification but not for aortic valve calcification (AVC). Its accuracy, association with aortic stenosis (AS) severity, and diagnostic and prognostic value with respect to AVC are unknown. METHODS AND RESULTS: In 30 explanted aortic valves, the AVC score by EBCT (1125+/-1294 Agatston units [AU]) showed a strong linear correlation (r=0.96, P<0.0001) with valvular calcium weight (653+/-748 mg) by pathology that allowed estimation of calcium weight as AVC score/1.7, with a small standard error of the estimate (53 mg). In 100 consecutive clinical patients, we measured AVC by EBCT and AS severity by echocardiographic aortic valve area (AVA). The AVC score was 1316+/-1749 AU (range 0 to 7226 AU). Intraobserver and interobserver variabilities were excellent (4+/-4% and 4+/-10%, respectively). AVC and AVA were strongly associated (r=0.79, P<0.0001) but had a curvilinear relationship that suggested that AVC and AVA provide complementary information. AVC score > or =1100 AU provided 93% sensitivity and 82% specificity for diagnosis of severe AS (AVA <1 cm2), with a receiver operator characteristic curve area of 0.89. AVC assessment by echocardiography was often more severe than by EBCT (P<0.0001). During follow-up, 22 patients either died, developed heart failure, or required surgery. With adjustment for age, sex, symptoms, ejection fraction, and AVA, the AVC score was independently predictive of event-free survival (risk ratio 1.06 per 100-AU increment [1.02 to 1.10], P<0.001), even after adjustment for echocardiographic calcifications. CONCLUSIONS: AVC is accurately and reproducibly measured by EBCT and shows a strong association and diagnostic value for severe AS. The curvilinear relationship between AVC and AVA suggests these measures are complementary, and indeed, AVC provides independent outcome information. Thus, AVC is an important measurement in the evaluation of patients with AS.