Study question: The many risk factors for coronary artery disease are associated with reduced production of nitric oxide (NO) by the endothelium. L-arginine supplementa¬tion appears to have modest clinical benefits in patients with angina. The effect of a medical food bar containing L-arginine, vitamin B6, B12, vitamin C, folic acid, and niacin was evaluated.
Methods: 36 patients with stable angina were random¬ized and had two treatment periods of 2 weeks’ duration.
Each group received two active bars or placebo bars. The brachial flow-mediated dilatation of the brachial artery in the arm was measured by ultrasonography.
Results: The medical food bar improved flow-mediated vasodilatation, treadmill exercise time, and quality of life scores. However, electrocardiographic signs of ischemia or time to onset of angina were not changed.
Perspective: Two other studies, however, have shown no benefit to endothelial function and exercise perfor¬mance in patients with coronary heart disease who were receiving medical management with statins and other agents. However, folic acid, vitamin B6, B12, vitamin C, and niacin may increase vascular NO activity and may have contributed here. Strategies that increase endo-thelial NO synthase activity and thus, endothelial NO bioactivity may lead to development of a new range of antianginal medications. These strategies include provision of cofactors for the enzyme NO synthase, enhancement of the transcription of the gene for this enzyme, and stabilization of messenger RNA (mRNA). Administration of the substrate L-arginine does not appear to be useful, but further studies are required.

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