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Use of amino acid supplement following a heart attack may be
harmful according to the VINTAGE MI clinical trial.
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Use of the amino acid supplement L-arginine following a
heart attack does not improve
certain cardiac functions and measurements and may be associated
with an increased risk of death, according to a study in the
January 4 issue of JAMA.
L-arginine is a widely available dietary supplement and is
publicized as having benefits for patients with
hypertension,
angina,
heart failure
and sexual dysfunction, according to background information in
the article. Prior studies suggest that L-arginine has the
potential to reduce vascular (blood vessel) stiffness.
Steven P. Schulman, M.D., of Johns Hopkins Medical
Institutions, Baltimore, and colleagues conducted the Vascular
Interaction with Age in Myocardial Infarction (VINTAGE MI)
clinical trial to test whether administering L-arginine to
patients following a first ST-segment elevation
myocardial
infarction (STEMI; a certain pattern on an
electrocardiogram
following a
heart attack) over a 6-month period would decrease vascular
stiffness and improve
ejection
fraction (a measure of how much blood the left ventricle of
the heart pumps out with each contraction).
The randomized, double-blind, placebo-controlled trial
included 153 STEMI patients; 77 were 60 years or older.
Participants were enrolled from February 2002 to June 2004.
Patients were randomly assigned to receive L-arginine (goal dose
of 3 g three times a day) or matching placebo for six months.
The researchers found: "The VINTAGE MI study demonstrated
that 6 months of L-arginine added to standard postinfarct
medications did not reduce noninvasive measures of vascular
stiffness, improve
ejection
fraction, or improve clinical outcomes. To the contrary, we
noted a possible increased risk of death in older patients after
infarction
while taking L-arginine compared with those taking a placebo,
leading to the early termination of the study. These findings
have broad public health implications given the increasing
availability and use of L-arginine in patients with and without
established cardiovascular diseases."
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Death occurred in 6 patients (8.6 percent) in the L-arginine
group died during the 6-month study period vs. none in the
placebo group.
"In conclusion, L-arginine therapy should not be given to
patients following a
myocardial
infarction. It neither alters noninvasive measures of
vascular stiffness nor improves left ventricular function. L-arginine
therapy in older patients with diffuse atherosclerosis may
worsen clinical outcomes," the authors write.
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JAMA.2005; 295:58-64
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