Clincal Briefs

By Louis Kuritzky, MD

Vitamin E Supplementation and Cardiovascular Events in High-Risk Patients

Observational studies indi-cate that persons who consume foods rich in vitamin E have a lower risk of coronary heart disease. Though such studies are useful for hypothesis generation, only randomized, controlled, interventional trials can provide the answer to whether at-risk persons can consume increased dietary or supplemental vitamin E and achieve a reduced risk of coronary end points. The Heart Outcomes Prevention Evaluation (HOPE) study is a double-blind randomized trial incorporating 400 IU of vitamin E daily over five years time in a group of patients considered high risk for cardiovascular events (n = 9541).

The primary end point was death from myocardial infarction (MI), stroke, and all cardiovascular causes combined. Secondary end points included death from any cause, and other cardiovascular end points like hospitalization for congestive heart failure (CHF).

There was no significant difference in death from cardiovascular causes, MI, coronary heart disease, or strokes. Overall mortality did not differ in the treated group from the untreated group. Similarly, secondary cardiovascular and combined outcomes demonstrated no favorable (or deleterious) effects from supplementation with vitamin E.

Yusuf and associates conclude that data from this large prospective trial among individuals with increased risk for cardiovascular end points show no benefit over five years for administration of supplemental vitamin E.

Yusuf S, et al. N Engl J Med 2000; 342:154-160.