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.

Bioactive compounds in lipid fractions of pumpkin (Cucurbita sp) seeds for use in food.

UNLABELLED: Seeds are considered to be agro-industrial residues, which can be used as source of macronutrients and/or raw material for extraction of vegetable oils, since they present great quantities of bioactive compounds. This study aimed to characterize the lipid fractions and the seeds of pumpkin (Cucurbita sp) varieties Nova Caravela, Mini Paulista, Menina Brasileira, and Moranga de Mesa aiming at using them in food. The chemical composition of the seeds was performed according to the official methods of American Oil Chemists' Society and Association of Official Analytical Chemists. Total carotenoids and phenolic compounds were determined by spectrophotometry, while the levels of tocopherols were analyzed by high efficiency liquid chromatography. It was noted that the seeds contain high amounts of macronutrients that are essential for the functioning of the human organism. As to total carotenoids, Mini Paulista and Menina Brasileira pumpkin varieties presented significant amounts, 26.80 and 26.03 µg/g, respectively. Mini Paulista and Nova Caravela pumpkin varieties showed high amounts of total phenolic compounds in the lipid fractions and in the seeds. It was also found that γ-tocopherol is the isomer that stood out in the lipid fractions and in the seeds, mainly in Menina Brasileira. Finally, the consumption of these seeds and use of lipid fractions provide the supply of large quantities of compounds that are beneficial for health and that may be potentially used in food, besides representing an alternative to better use of agro-industrial residues. PRACTICAL APPLICATION: Bioactive compounds, besides presenting basic nutritional functions, provide metabolic and physiological health benefits when consumed as part of the usual diet. Therefore, there is a growing interest in vegetable oils of special composition, such as the ones extracted from fruit seeds. The seeds of Cucurbita sp are shown to be promising sources of oils, and especially the Cucurbita moschata and maxima species have not yet been fully elucidated. For this reason, it becomes important to investigate the chemical composition and lipid fractions of these seeds, aiming to use them in food.

Canadian Outcomes Study in Dementia: study methods and patient characteristics.

OBJECTIVE: To describe the methods and patient characteristics of the Canadian Outcomes Study in Dementia (COSID). METHODS: COSID is a 3-year prospective study of dementia patients living in the community at the time of study registration. We assessed patients' cognition, behaviour, and functioning every 6 months, using the Modified Mini-Mental State Examination (3MS), the Neuropsychiatric Inventory (NPI), and the Functional Autonomy Measurement System (SMAF), respectively. We assessed caregivers, using the Zarit Burden Interview (ZBI). Additional information included the Global Deterioration Scale (GDS), patients' driving status, and clinical information including family history, dementia type, concomitant medications, and comorbid conditions. From the patient or caregiver, we collected details of inpatient and outpatient resources used by the patient and (or) caregiver. RESULTS: We enrolled 766 patients from 31 Canadian sites. Overall mean age was 76.8 years, and mean age of onset was 73.1 years. Of the total patients, 98% were white, 54% were women, and 84% were diagnosed with Alzheimer's disease. Mean baseline 3MS was 66.5, NPI was 9.5, and SMAF was 18.30. Of these patients, 48% reported a GDS score of 3 (that is, moderate), 16% reported a GDS score of 4 (that is, moderately severe), and the remaining 36% reported a GDS score of 1 or 2 (that is, mild or very mild). At baseline, 83% of patients received cholinesterase inhibitors, 46% received nonsteroidal antiinflammatory drugs, 39% received vitamin E, and 25% received antidepressants. Adult day care and home help were the largest cost factors in this population, with mean monthly costs of $65 and $64, respectively. We found interesting differences in the resources used among geographic regions and care settings. CONCLUSIONS: COSID is already generating valuable information about treatment patterns, outcomes, and resource use in Canadian patients with dementia. As the data mature, it will be possible to build robust models on treatment effectiveness and costs of care.

Nutritional strategies in cardiovascular disease control: an update on vitamins and conditionally essential nutrients.

Several nutritional interventions for cardiovascular disease (CVD) prevention and therapy have recently appeared in the biomedical literature. These include appropriate use of several vitamins (E, C, B6, folate) and conditionally essential nutrients (CoQ10, L-arginine, propionyl L-carnitine). Possible undesirable consequences of long term nutritional supplementation with vitamin E and of adverse drug-nutrient interactions between the statins and CoQ10 are also considered. Although additional intervention studies are needed, current scientific evidence generally supports nutritional supplementation with these nutrients as an effective adjunctive strategy for CVD control.

Cost-effectiveness of vitamin E therapy in the treatment of patients with angiographically proven coronary narrowing (CHAOS trial). Cambridge Heart Antioxidant Study.

Epidemiologic studies have suggested that vitamin E (alpha-tocopherol) may play a preventive role in reducing the incidence of atherosclerosis. The aim of this paper was to conduct a cost-effectiveness analysis of vitamin E supplementation in patients with coronary artery disease using data from the Cambridge Heart Antioxidant Study (CHAOS). The study compared cost-effectiveness in the context of Australian and United States (US) health care utilization. The main clinical outcome used in the economic evaluation was the incidence of acute myocardial infarction (AMI) which was nonfatal. Utilization of health care resources was estimated by conducting a survey of Australian clinicians and published Australian and US cost data. Cost savings of $127 (A$181) and $578/patient randomized to vitamin E therapy compared with patients receiving placebo were found for Australian and US settings, respectively. Savings in the vitamin E group were due primarily to reduction in hospital admissions for AMI. This occurred because the vitamin E group had a 4.4% lower absolute risk of AMI than did the placebo group. Less than 10% of health care costs in the Australian evaluation was due to vitamin E ($150 [A$214/patient]). Our economic evaluation indicates that vitamin E therapy in patients with angiographically proven atherosclerosis is cost-effective in the Australian and US settings.

Adverse effects of Escherichia coli infection of turkeys were not alleviated by supplemental dietary vitamin E.

Two experiments were conducted to determine the influence of dietary vitamin E on the response of young male turkeys to Escherichia coli infection. A complete factorial arrangement of two concentrations of supplemental dietary vitamin E (12 or 300 IU/kg as dl-alpha-tocopheryl acetate) and infection or no infection of turkeys with E. coli was used in both experiments. In Experiment 1, each dietary treatment was fed to four pens of turkeys from 1 to 28 d of age. At 28 d, turkeys in two pens per dietary treatment received an injection of 3.0 x 10(7) E. coli cells into the left and right thoracic air sacs. All turkeys were necropsied 7 d after E. coli injection and the incidence and severity of lesions in air sacs, lungs, pericardium, and liver were determined. The same dietary vitamin E treatments were used in Experiment 2. Each diet was fed to eight pens of turkeys from 1 to 47 d of age. At 47 d, turkeys in four pens per dietary treatment received an injection of 3.0 x 10(7) cells of the same E. coli used in Experiment 1 into the left and right thoracic air sacs. All turkeys were necropsied as in Experiment 1 at 54 d of age. Weight gain and efficiency of feed utilization were impaired markedly by E. coli infection during the 7 d after injection. Livability also was decreased by E. coli infection in Experiment 1 but not in Experiment 2. Adverse effects of E. coli on performance and livability were not affected by dietary vitamin E concentration. Lesions observed in turkeys that received E. coli injection ranged from mild to severe, with the most severe lesions observed in air sacs. Lung lesions were observed frequently but were less severe than in air sacs. Dietary concentration of vitamin E had no effect on incidence or severity of lesions in air sacs or lungs. Overall, the results of these experiments show that adding 300 IU of vitamin E/kg of diet did not alleviate the adverse effects of E. coli infection in young turkeys.