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VITAMIN E STUDY
There is now clear evidence, both epidemiological and from random clinical trials, that vitamin E, at or above a certain daily intake, can dramatically reduces the risk of heart disease. It is difficult to overstate the importance of this result given that heart disease kills about 1 million Americans per year (13 million world wide), causes suffering to many more, and costs in excess of 100 Billion.
Questions:
So, why not just declair that everyone should take vitamin E?
What is the RDA for Vitamin E? Should it be changed?
The important results are summarized in a recent review by Diaz et. al. in The New England Journal of Medicine, vol 337, Aug 7, 1997, pp 408-416. Here is an excerpt. Pay careful attention to the daily intake of vitamin E used in these studies. It goes to the heart of an important issue.
"There is a wealth of epidemiologic data linking the dietary and supplemental intake of antioxidant vitamins with a reduction in the clinical manifestations of atherosclerosis (*(Table 1)*). Initially, these data were limited to descriptive studies in European and North American populations (reviewed by Gaziano et al. (12)). Subsequent case-control studies indicated that patients with angina pectoris have lower plasma concentrations of vitamin E than normal subjects (13) and that reduced concentrations of vitamin C in the leukocytes are predictive of angiographically evident coronary artery disease. (4)"
"These results have been confirmed in recent prospective cohort studies. In the Nurses' Health Study (5) and the Health Professionals' Follow-up Study, (6) there was a 35 to 40 percent reduction in the incidence of major coronary events (nonfatal myocardial infarction and death from cardiac causes) among the subjects in the highest quintile of vitamin E intake over a four-to-eight-year follow-up period, as compared with those in the lowest quintile. The benefit was greatest in subjects taking 100 to 250 IU of supplemental vitamin E per day, with little further benefit at higher doses. There was no relation between vitamin C intake and major coronary events in either study, but in another study, subjects whose vitamin C intake exceeded 50 mg per day had a lower rate of death from all cardiovascular diseases. (7)"
"The results of recent randomized trials to investigate whether there is a cause-and-effect relation between antioxidant intake and a reduction in coronary artery disease have been mixed. In the Alpha-Tocopherol, Beta Carotene Cancer Prevention Study, Finnish smokers were treated with beta carotene, (alpha)-tocopherol (vitamin E), both, or neither daily for five to eight years. There was no benefit with respect to coronary artery disease for either compound, (9) but the dose of (alpha)-tocopherol (50 mg per day) was below the protective range suggested by both the Nurses' Health Study and the Health Professionals' Follow-up Study. (5,6) There was no reduction in deaths from cardiovascular causes among physicians receiving supplemental beta carotene over a 12-year period in the Physicians' Health Study. (10) In contrast, in the Cambridge Heart Antioxidant Study, in which 2002 patients with angiographically evident coronary artery disease were treated with (alpha)-tocopherol (400 to 800 IU per day) or placebo, there was a 77 percent reduction in nonfatal myocardial infarction in the group receiving (alpha)-tocopherol during a median follow-up period of 510 days. (11)"
"In summary, descriptive, case-control, and prospective cohort studies have found inverse associations between the frequency of coronary artery disease and dietary intake of antioxidant vitamins. Randomized therapeutic trials have thus far shown no benefit with beta carotene and a possible benefit with vitamin E."
This summary does not adequately address the very important public health policy and ethical issues: Given the considerable and unanimous epidemiological evidence showing an approximately 40 percent reduction in risk for vitamin E takers, together with the one clinical intervention trial showing a 77 percent reduction in non-fatal MIs (at what daily intake?), and that the only known side effect is an extended blood clotting time (as one would expect to see when taking an aspirin every other day), should physicians recommend to their patients that they take vitamin E to lower their risk of heart disease?
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