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October 8, 1997

Contempo 1997: Family Medicine

Author Affiliations

McGuire Medical Group Richmond, Va

JAMA. 1997;278(14):1151. doi:10.1001/jama.1997.03550140043034

To the Editor.  —The Contempo article on family medicine1 makes a statement that is a bit of a stretch. The authors list vitamin E along with estrogen for women and antiplatelet agents as "powerfully protective and underused in primary prevention." In a recent study by Rapola et al2 evaluating the effect of alpha tocopherol and beta carotene supplements on the incidence of cardiovascular events in men with previous myocardial infarction, the authors note, "The results from clinical trials of antioxidant supplementation in people with known coronary heart disease are inconclusive." They also state, "In conclusion, both alpha-tocopherol and beta-carotene increased the risk of fatal coronary heart disease. Based on these findings, we recommend that patients with a previous myocardial infarction who smoke should not use these agents. Further studies will provide information about the safety and efficacy of antioxidants in secondary prevention of coronary heart disease." It appears