title: Cholesterol standardized plasma vitamin E levels are reduced in patients with severe angina pectoris.
abstract: Vitamin E, the major lipid soluble plasma antioxidant, has been reported to be reduced in patients with coronary atherosclerosis. We have measured the levels of plasma alpha-tocopherol (the predominant form of plasma vitamin E) in 128 patients with different reported degrees of angina. Patients with mild to moderate angina (grades I or II (CSS score)) (n = 64), and patients with severe angina (grades III and IV) (n = 64) were recruited from Cardiology Clinics in the U. K. Healthy controls (n = 33) and patients with hyperlipidaemia (n = 28) were also recruited. The groups of patients with angina did not differ significantly for mean age (58 +/- 1.0 years vs. 59 +/- 1.0 years, respectively); sex distribution (the M:F ratio was 48 : 16 and 46 : 18 for the respective groups); or prevalence of smoking (12% vs. 9%), or hypertension (19% vs. 33%). Total cholesterol levels were higher in the group with severe angina (5.9 +/- 0.16 mmol/l vs. 5.3 +/- 0.13 mmol/l P < 0.05). Absolute levels of plasma vitamin E were not significantly different between the angina subgroups (12.9 +/- 0.40 mg/l for the mild-moderate angina group vs. 12.5 +/- 0.51 mg/l for the severely affected group), but were positively correlated with plasma cholesterol concentrations in each case (P < 0.001). The ratio between plasma vitamin E: total cholesterol was significantly lower in the patients with severe angina (mean 2.20 +/- 0.09 mg/mmol) vs. a mean value of 2.46 +/- 0. 08 mg/m mol in the mildly affected group (P < 0.05). The plasma vitamin E: total cholesterol ratio in patients with severe angina was also significantly lower (P < 0.05) compared to either healthy controls with comparable total cholesterol levels (n = 33), or hypercholesterolaemic subjects (n = 28) without symptomatic coronary disease (mean ratios were 2.69 +/- 0.40 mg/mmol and 2.74 +/- 0.68 mg/mmol, respectively). Vitamin E has previously been demonstrated to protect endothelial function in the presence of hypercholesterolaemia, possibly by preserving nitric oxide bio-activity. It also inhibits LDL oxidation. Hence, a high plasma vitamin E: total cholesterol ratio may be associated with an amelioration of angina.
authors.affiliation: Department of Clinical Biochemistry, The Royal Surrey County Hospital, Guildford, Surrey. g.ferns@surrey.ac.uk
authors.forename: G
authors.initials: G
authors.lastname: Ferns
authors.forename: J
authors.initials: J
authors.lastname: Williams
authors.forename: L
authors.initials: L
authors.lastname: Forster
authors.forename: S
authors.initials: S
authors.lastname: Tull
authors.forename: B
authors.initials: B
authors.lastname: Starkey
authors.forename: A
authors.initials: A
authors.lastname: Gershlick
mesh_terms: D000328:Adult; D000368:Aged; D000787:Angina Pectoris / Q000097:blood*; D016022:Case-Control Studies; D002784:Cholesterol / Q000097:blood; D005260:Female; D006801:Humans; D006949:Hyperlipidemias / Q000097:blood; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D014810:Vitamin E / Q000097:blood*
chemical_list: D014810:Vitamin E; D002784:Cholesterol