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Vitamin E

July 1st, 2005

For a time, vitamin E supplements looked like an easy way to prevent heart disease. Promising observational studies, including the Nurses’ Health Study and Health Professionals Follow-up Study, suggested 20% to 40% reductions in coronary heart disease risk among individuals who took vitamin E supplements (usually containing 400 IU or more) for least two years.

The results of several randomized trials have dampened enthusiasm for vitamin E’s ability to prevent heart attacks or deaths from heart disease among individuals with heart disease or those at high risk for it. In the GISSI Prevention Trial, the results were mixed but mostly showed no preventive effects after more than three years of treatment with vitamin E among 11,000 heart attack survivors. Results from the Heart Outcomes Prevention Evaluation (HOPE) trial also showed no benefit of four years worth of vitamin E supplementation among more than 9,500 men and women already diagnosed with heart disease or at high risk for it. Based on these and other studies, the American Heart Association has concluded that “the scientific data do not justify the use of antioxidant vitamin supplements [such as vitamin E] for CVD risk reduction.”

A recent scientific analysis raised questions about whether high doses of vitamin E supplements might increase the risk of dying.The authors gathered and re-analyzed data from 19 clinical trials of vitamin E, including the GISSI and HOPE studies; they found a higher rate of death in trials where patients consumed more than 400 IU of supplements per day. While this meta-analysis drew headlines when it was released online in November 2004, there are limitations to the conclusions that can be drawn from it. Some of the findings are based on very small studies; furthermore, many of the high-dose trials of Vitamin E included in the analysis were done on people who had chronic diseases, such as heart disease or Alzheimer’s disease. So it is not clear that these findings would apply to healthy people.

It’s entirely possible that in secondary prevention trials, the use of drugs such as aspirin, beta blockers, and ACE inhibitors mask a modest effect of vitamin E, and that it may have benefits among healthier people. Ongoing randomized trials of vitamin E, such as the Women’s Health Study and SU.VI.MAX will tell us more about its possible benefits in the coming years.

Vitamin E Optimal Intake: The recommended daily intake of vitamin E from food now stands at 15 milligrams from food. That’s the equivalent of 22 IU from natural-source vitamin E or 33 IUs of the synthetic form. Researchers are still writing the book on vitamin E. Some small studies have suggested that vitamin E supplements might interfere with statins, but this hypothesis was refuted in a large trial. While the data are sparse and conflicting, evidence from some observational studies suggests that at least 400 IU of vitamin E per day, and possibly more, are needed for optimal health. Since standard multivitamins usually contain around 30 IU, a separate vitamin E supplement is needed to achieve this level. Current guidelines say that consuming more than 1000 mg of supplemental vitamin E per day is not considered safe; that’s the equivalent of a supplement with 1,500 IU of natural-source vitamin E or 1,100 IU of synthetic vitamin E.

Entry Filed under: Vitamins & Minerals

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