This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Edelman, E. R. Search for Related Content PubMed PubMed Citation Articles by Edelman, E. R. Pubmed/NCBI databases Compound via MeSH Substance via MeSH Medline Plus Health Information Angioplasty Antioxidants

(Circulation. 1998;97:416-420.)
© 1998 American Heart Association, Inc.

Editorials

Vessel Size, Antioxidants, and Restenosis

Never Too Small, Not Too Little, but Often Too Late

Elazer R. Edelman, MD, PhD

From Harvard-MIT Division of Health Science and Technology, Cambridge Mass, and the Brigham and Women's Hospital, Harvard Medical School, Boston, Mass.

Correspondence to Elazer R. Edelman, MIT 56–341, Cambridge, MA 02139.

Key Words: Editorials • angioplasty • antioxidants • restenosis

The angioplasty restenosis experience of the last 20 years has left us with two disturbing ideas: first, that pharmacological control of this disease may well be beyond reach; and second, that animal models of restenosis simply cannot predict pharmacological success. Two recent double-blinded clinical trials with probucol therapy for elective angioplasty, the MultiVitamins and Probucol (MVP) trial¹ and the Probucol Angioplasty Restenosis Trial (PART),² offer sustaining hope. Each study sought to examine the role of oxidative stress on restenosis through the use of dietary intake of antioxidants and assessment of effect with quantitative angiography. Whereas the MVP trial examined the differential effects of probucol and the combination of vitamins C and E with ß-carotene, the PART trial compared probucol with placebo alone. The probucol arms of these studies were based on the same fundamental cell culture and preclinical animal experiments, used virtually identical designs, and produced nearly identical reductions in restenosis (Table). As reported in this issue of Circulation, Rodes et al³ have extended analysis of the MVP trial post hoc to patients with small-diameter vessels. As with a similar subgroup analysis of the PART trial,⁴ the benefit of probucol was retained in vessels <2.7 mm in diameter (Table), and as in the parent MVP trial with all patients and arteries of all sizes, the addition of vitamins C and E with ß-carotene negated the beneficial effect.

View this table: [in this window] [in a new window]   Table 1. Summary of Data From Clinical Trials Examining Probucol in Angioplasty Restenosis

Taken together, this study,³ the parent MVP . . . [Full Text of this Article]

This article has been cited by other articles:

				R. J. Pettersen, Z. A. Muna, K. K.J. Kuiper, E. Svendsen, F. Muller, P. Aukrust, R. K. Berge, and J. Erik Nordrehaug Sustained retention of tetradecylthioacetic acid after local delivery reduces angioplasty-induced coronary stenosis in the minipig Cardiovasc Res, November 1, 2001; 52(2): 306 - 313. [Abstract] [Full Text] [PDF]

				J. Orbe, J. A Rodriguez, A. Calvo, A. Grau, M. S Belzunce, D. Martinez-Caro, and J. A Paramo Vitamins C and E attenuate plasminogen activator inhibitor-1 (PAI-1) expression in a hypercholesterolemic porcine model of angioplasty Cardiovasc Res, February 1, 2001; 49(2): 484 - 492. [Abstract] [Full Text] [PDF]

				M. R. Brown, F. J. Miller Jr, W.-G. Li, A. N. Ellingson, J. D. Mozena, P. Chatterjee, J. F. Engelhardt, R. M. Zwacka, L. W. Oberley, X. Fang, et al. Overexpression of Human Catalase Inhibits Proliferation and Promotes Apoptosis in Vascular Smooth Muscle Cells Circ. Res., September 17, 1999; 85(6): 524 - 533. [Abstract] [Full Text] [PDF]