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Oxidation of low-density lipoprotein (LDL) probably plays an important part in atherosclerosis. Vitamin E (alpha-tocopherol) is a potent antioxidant carried in LDL. It increases the resistance of LDL to oxidation, thereby, among other things, inhibiting foam cell formation and proliferation of smooth muscle cells. Some animal experiments have indicated that vitamin E retards the development of atherosclerotic lesions. Observational studies (case-control and cohort) have shown that long-term treatment with vitamin E is associated with lower incidence of coronary heart disease in men and women alike. Randomisation to vitamin E in a large placebo controlled trial gave a nonsignificant reduction in mortality from ischemic heart disease. Although vitamin E seems to reduce the risk of coronary heart disease, randomised trials of adequate size are necessary in both secondary and primary prevention in order to test this. Such trials are in progress.

The new drug, sumatriptan, used to treat migraine, causes substernal tightness and severe angina-like pain in 3-21% of patients. Several reports have described sumatriptan-induced death, ventricular fibrillation, myocardial infarction, ischaemia and coronary vasospasm. We describe the case of a woman aged 40 years who suffered from bronchial asthma but was without known coronary heart disease. She experienced chest pain after intake of 100 mg sumatriptan orally. ECG was normal and there was no increase in coronary enzymes. Sumatriptan has a weak coronary constrictor effect. Endothelial dysfunction, with reduced release of vasodilating nitric oxide, may potentiate vasoconstriction induced by sumatriptan in the presence of thromboxane A2.

A group of chest physicians, general practitioners, clinical pharmacologist and pharmacists appointed by the Institute of Pharmacotherapy, University of Oslo has evaluated the present knowledge about treatment of chronic obstructive lung disease. The group discusses today's medical treatment of this rather numerous group of patients. It is stated that, to a high degree, the treatment of these patients lacks proper documentation, and that treatment needs to be tested out on an individual basis. The group proposes a flow chart for this purpose.

Thiazide treatment is a first-line choice for hypersensitive patients: Thiazides have a flat dose-response as regards blood pressure, but induce biochemical changes only at higher doses. Given in low doses, which careful monitoring of potassium, thiazides provide adequate control of blood pressure without having any substantial impact on blood glucose. In high doses, thiazides may induce three to six new cases of impaired glucose tolerance per 1,000 patient years. The thiazide-induced changes in blood glucose can be prevented by giving lower doses and correcting hypokalaemia, and can be reversed by stopping the drug. In most diabetics, low doses of thiazides do not seem to diminish control of blood glucose. The well-documented effect of thiazides in reducing cardiovascular morbidity and mortality, their safety and their low price make them an excellent first-line choice for treatment of hypertension.