A US randomised trial in this week’s issue of THE LANCET suggests that vitamin C and E supplementation could be of clinical benefit in delaying the onset of arteriosclerosis in the first year after heart transplantation.

Around 70% of patients develop arteriosclerosis within three years after heart transplantation, which is thought to be associated with oxidant stress. James Fang and colleagues from Brigham and Women`s Hospital, Boston, USA, proposed that treatment with antioxidant vitamins C and E would slow the progression of transplant-associated arteriosclerosis.

40 patients (0-2 years after heart transplantation) were randomly assigned vitamin C 500 mg plus vitamin E 400 IU, each twice daily, or placebo, for 1 year. The primary endpoint was the change in average intimal index (plaque area divided by vessel area) measured by intravascular ultrasonography (IVUS). Coronary endothelium-dependent vasoreactivity was assessed with intracoronary acetylcholine infusions. IVUS, coronary vasoreactivity, and vitamin C and E plasma concentrations were assessed at baseline and at 1 year follow-up.

Vitamin C and E concentrations increased in the treatment group, but not in the placebo group, as expected. During 1 year of treatment, the intimal index increased in the placebo group by 8% but did not change significantly in the treatment group. Coronary endothelial function remained stable in both groups.

James Fang comments: “Our results suggest that vitamins C and E provide a clinically useful approach to reducing arteriosclerosis after cardiac transplantation. Antioxidant therapy with these vitamins may also be useful in other solid-organ allografts, such as kidney, lung, and liver transplants, in which obliteration of vascular or tubular structures limits long-term success. Further investigations are warranted to investigate whether the beneficial effects of vitamins C and E are sustained over many years when most of the clinical complications resulting from transplant-associated arteriosclerosis occur.”