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Vitamin E Supplementation: What to Do?

Results from an extension of the HOPE trial suggest risks are associated with vitamin E; clinicians will have to balance these risks against the potential ophthalmologic benefits.

Despite observational evidence that vitamin E supplementation is associated with decreased risk for cardiovascular disease and cancer, clinical trial results have been disappointing. In a previously published, randomized, placebo-controlled trial of vitamin E (400 IU daily) in 9541 subjects (age 55) with known vascular disease or diabetes, researchers found no effect for vitamin E on the incidence of cardiovascular events after a mean follow-up of 4.5 years (Journal Watch Jan 25 2000). In this extension of that trial, 3994 subjects agreed to continue receiving their assigned treatment, and an additional 738 agreed to continue passive follow-up; data were carried forward for all 9541 subjects.

During a median follow-up of 7 years, no significant differences were noted between the vitamin E and placebo groups in cancer incidence, cancer deaths, or the combined endpoint of myocardial infarction, stroke, or cardiovascular death (21.5% vs. 20.6%). Vitamin E recipients did have a significantly higher risk for heart failure than did placebo recipients (13.5% vs. 12.1%).

Comment: Many U.S. adults take vitamin E supplements. These data -- along with a recent meta-analysis that suggested increased all-cause mortality with high-dose (400 IU) vitamin E supplementation -- are certain to cause concern. In addition, increased risk for heart failure is a new finding that merits further study. However, in an important ophthalmology trial, an antioxidant-plus-zinc combination that included 400 IU of vitamin E daily delayed the progression of age-related macular degeneration (Journal Watch Oct 26 2001). As noted in a recent Archives of Ophthalmology editorial, clinicians will need to balance the potential risks of vitamin E therapy against the potential ophthalmologic benefits.

— Thomas L. Schwenk, MD

Published in Journal Watch General Medicine March 29, 2005

Citation(s):

The HOPE and HOPE-TOO Trial Investigators. Effects of long-term vitamin E supplementation on cardiovascular events and cancer: A randomized controlled trial. JAMA 2005 Mar 16; 293:1338-47.

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