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This specific antioxidant combination was developed by the University of Washington for use in the HDL-Atherosclerosis Treatment Study (HATS). The cocktail consists of vitamin E (800 IU daily), vitamin C (1000 mg daily), beta-carotene (25 mg daily), and selenium (100 micrograms daily), typically administered in two divided doses. The therapeutic rationale was based on the hypothesis that exogenous antioxidants could prevent the oxidation of low-density lipoprotein (LDL) and reduce oxidative stress, thereby slowing the progression of coronary artery disease, particularly in patients with low HDL cholesterol. However, in a Phase 3 randomized controlled trial, the combination failed to demonstrate clinical benefit in reducing coronary stenosis or cardiovascular events. Furthermore, it was observed to blunt the beneficial rise in HDL2 cholesterol levels typically induced by simvastatin-niacin therapy.
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