Cholesterol standardized plasma vitamin E levels are reduced in patients with severe angina pectoris

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 ol-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 recruit ed from Cardiology Clinics in the U.K. Healthy controls (n = 33) and patien ts with hyperlipidaemia (n = 28) were also recruited. The groups of patients with angina did not differ significantly for mean ag e (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 no t 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 con centrations in each case (P < 0.001). The ratio between plasma vitamin E: t otal 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 mot in the mildly affected group (P < 0.05). The plasma vitamin E: total choleste rol 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 sympto matic 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 oxi de bio-activity. It also inhibits LDL oxidation. Hence, a high plasma vitam in E: total cholesterol ratio may be associated with an amelioration of ang ina.