II. VITAMIN E
7. Vitamin E in Heart Failure
Randomized trials to examine the benefits of vitamin E have not been carried out in patients with heart failure. A small study of patients with dilated cardiomyopathy showed that the combination of vitamin E and C reduced plasma levels of malondialdehyde and superoxide anion and elevated the levels of antioxidant enzymes. The com¬bined treatment with vitamin C and E has been shown to suppress neutrophil-mediated free radical production and lower blood lipid peroxidation product in patients with acute myocardial infarction. The role of vitamin E either alone or in combination with vitamin C in patients with heart failure deserves to be further studied, par¬ticularly because oxidative stress is present in the failing heart. Gotto et al. emphasized that ‘‘we cannot discount the oxidation hypothesis in human atherosclerosis, and experiments to date have only illustrated the difficulties in testing this complex issue.’’