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Little Benefit to Aspirin or Vitamin E in Women

Aspirin and vitamin E are not effective in preventing cancer or cardiovascular disease in women.

In the Women’s Health Study, aspirin was associated with a nonsignificant reduction in cardiovascular outcomes and an increase in bleeding (Journal Watch Mar 18 2005). Now, in a report from the same study, researchers have evaluated whether aspirin might prevent cancer — and whether vitamin E might prevent cancer or cardiovascular disease. A total of 39,876 women without known cancer or cardiovascular disease (age, 45) were randomized to receive aspirin (100 mg every other day), vitamin E (600 IU every other day), both, or neither.

During an average follow-up of 10 years, 2865 cases of cancer were confirmed (excluding nonmelanoma skin cancer). In intent-to-treat analyses, neither aspirin nor vitamin E had any significant effect on the incidence of cancer overall, on the incidence of breast, colorectal, or lung cancer, or on overall cancer mortality rate.

During the same follow-up period, 999 major cardiovascular events occurred. Vitamin E did not significantly affect the incidence of myocardial infarction, ischemic stroke, or hemorrhagic stroke. However, it was associated with 24% fewer deaths from cardiovascular disease, mostly because fewer sudden cardiac deaths occurred in the vitamin E group (38, vs. 51 in the placebo group).

Comment: Plausible hypotheses exist for why aspirin and vitamin E might be effective in preventing cancer and cardiovascular disease. However, these results and previous findings show no significant benefit in reducing cancer risk or death from cancer. Vitamin E might have a small benefit in preventing sudden cardiac death, but this possibility requires more evaluation, given that vitamin E did not reduce the incidence of cardiovascular disease in this study.

— Thomas L. Schwenk, MD

Published in Journal Watch General Medicine August 2, 2005

Citation(s):

Cook NR et al. Low-dose aspirin in the primary prevention of cancer: The Women's Health Study. A randomized controlled trial. JAMA 2005 Jul 6; 294:47-55.

• Original article (Subscription may be required)
• Medline abstract (Free)

Lee I-M et al. Vitamin E in the primary prevention of cardiovascular disease and cancer: The Women's Health Study. A randomized controlled trial. JAMA 2005 Jul 6; 294:56-65.

• Original article (Subscription may be required)
• Medline abstract (Free)