Research Update
Vitamin E not a heartfelt protector
CMAJ 2000;162:1196
Some studies have suggested that vitamin E reduces the risk of coronary disease and atherosclerosis. But after almost 5 years of study, researchers involved with the Heart Outcomes Prevention Evaluation (HOPE) study have concluded that vitamin E has no apparent effect on outcomes for patients at high risk of cardiovascular disease (N Engl J Med 2000;342:154-60).
"What this really means is that we should really not be prescribing vitamin E for the prevention of heart disease — at least, not yet. Vitamin E has not had a protective effect, at least over 4 and a half years," says lead investigator Dr. Salim Yusuf, professor of medicine and director of cardiology at McMaster University in Hamilton, Ont.
More than 9500 men and women, who were all 55 years of age or older and at high risk for cardiovascular events, were randomly assigned to receive either 400 IU of vitamin E a day or a placebo. A total of 772 patients (16.2%) assigned to the treatment group experienced a primary outcome event, compared with 739 patients (15.5%) in the control group. As well, there were no significant differences in the numbers of deaths as a result of cardiovascular disease (342 in the vitamin E group versus 328 in the control group), myocardial infarction (532 versus 524), or stroke (209 versus 180). The researchers also found no significant differences in the incidence of secondary cardiovascular outcomes or in death from any cause. They also found no serious adverse effects of vitamin E.
"We found that [vitamin E] is safe. That doesn't mean we should use it. There is a cost to vitamins. Patients' money would be better spent elsewhere," says Yusuf, who recommends that physicians advise their patients to stick with the tried and true, such as stopping smoking and exercising regularly.
The vitamin E component of the HOPE study has now been extended for another 3 years. In addition to investigating the association with heart disease, the researchers are also looking to see if there is a link between vitamin E and the prevention of cancer. "This is a really promising area," notes Yusuf. "Studies suggest positive results." — Donalee Moulton, Halifax
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