Thatchers Thoughts: Cardiovascular

Aspirin, vitamin E, and cardiovascular disease

Title: Low-dose aspirin and vitamin E in people at cardiovascular risk: A randomized trial in a general practice 
Author: M. Roncaglioni, et al.
Address: Milan, Italy 
Source: The Lancet 357:89-95 (January) 2001

Summary: The intent of this study was to determine in general practice the effectiveness of antiplatelets and antioxidants in primary prevention of cardiovascular events in people with one or more major cardiovascular risk factors. The study was a randomized controlled open 2×2 factorial trial to investigate low-dose aspirin (100 mg/day) and vitamin E (300 mg/day) in the prevention of cardiovascular events, in people with one or more of the following characteristics: hypertension, hypercholesterolaemia, diabetes, obesity, family history of premature myocardial infarction, or individuals who were elderly. The patient group consisted of 4495 people, 2583 of whom were female with an average age of 64.4 years. Researchers found that aspirin lowered the frequency of all the endpoints, being significant for cardiovascular death (from 1.4 to 0.8%) and total cardiovascular events (from 8.2 to 6.3%). However, severe bleedings were more common in the aspirin group than the no-aspirin group (1.1% vs. 0.3%). Vitamin E was found to have no effect on any endpoint. It was concluded that in women and men at risk of having a cardiovascular event because of the existence of at least one major risk factor, low-dose aspirin given as a supplement to treatment of specific risk factors contributes an additional preventive effect, with an acceptable safety profile. 
Comment: This confirms other studies on the value of aspirin. Curious about vitamin E.


Plant estrogens

Title: The role of isoflavones in menopausal health: consensus opinion of the North American Menopause Society
Author: Board of Trustees of the North American Menopause Society
Address: Cleveland, OH
Source: The Journal of the North American Menopause Society 7:215-229 (July-Aug.) 2000

Summary: The North American Menopause Society set out to create an evidence-based consensus opinion of the role of isoflavones in menopausal health. To develop their opinion, they relied on a panel of clinicians and researchers who were experts in the field of isoflavones. Data are inconclusive regarding whether the observed health effects in humans are attributable to isoflavones alone or to isoflavones plus other components in whole foods. The most convincing health effects have been attributed to the actions of isoflavones on lipids. Studies have associated isoflavones with statistically significant reductions in low-density lipoproteins and triglycerides as well as increases in high-density lipoproteins. There is not enough data available to evaluate the effect of isoflavones on breast and other female-related cancers, bone mass, and vaginal dryness. The committee concluded that foods or supplements that contain isoflavones clearly have some physiologic effects. Whole foods that contain isoflavones may be recommended, especially for their cardiovascular benefits. However, physicians need to exercise some caution when recommending isoflavones, as clinical trials are needed before specific recommendations can be made about increased consumption of isoflavone rich food or supplements.

Comment: A consensus about lack of consensus. If plant estrogens were beneficial, it would seem that the data should be clearer. Certainly there are mega-dollars on the table in sorting out this issue.


Plant sterol

Title: Health claim for plant sterol, plant stanol esters
Author: Food and Drug Administration 
Date: September 2000

Summary: The Food and Drug administration issued an interim final rule authorizing the use of health claims on food labels concerning the role of plant sterol or plant stanol esters in reducing the risk of coronary heart disease. According to the agency, a food must contain at least 0.65 grams of plant sterol esters per serving or at least 1.7 grams of plant stanol esters per serving to qualify for the health claim. The label must specify that the daily dietary intake should be consumed in 2 servings, which must be eaten at different times of the day with other foods. Additionally, a food must be low in saturated fat and cholesterol to carry the health claim, and meet other nutritional requirements described by the FDA.

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