Vitamin E modulation of C-reactive protein in smokers with acute coronary syndromes

Acute coronary syndromes are characterized by the expression of proinflammatory cytokines such as C-reactive protein (CRP). Sustained upregulation of inflammatory markers is associated with an adverse prognosis. Vitamin E is known to have significant anti-inflammatory properties and has been associated with a reduction in cardiovascular events in some studies of high-risk patients. The mechanism of benefit remains controversial. We conducted a randomized, double-blind placebo controlled trial of vitamin E 400 IU daily for 6 months in 110 patients with acute coronary syndromes. Serum samples were collected at enrollment and at 2, 4, and 6 months. CRP, interleukin-6 and the soluble cell adhesion molecules were measured. Vitamin E levels increased significantly in the treatment group (from 31 μmol/l at baseline to 51 μmol/l, p < .0001) and were unchanged in the placebo group (32 μmol/l at baseline to 34 μmol/l, p = NS). CRP levels fell in both the vitamin E group and the placebo group over the treatment period (from 17.2 ± 2.9 to 6.1 ± 0.8 mg/l and from 21.5 ± 4.9 to 5.9 ± 0.9 mg/l, p = NS for the difference between active and placebo groups). However, vitamin E treatment was associated with significantly lower 6 month CRP levels in smokers versus smokers on placebo (4.7 ± 0.71 mg/l vs. 8.26 ± 1.5 mg/l, p = .02). Vitamin E reduces CRP levels in smokers with acute coronary syndromes for up to 6 months after hospitalization.