Skip to main content

Clinical Cardiovascular Disease Trials: The Vitamin E Case

  • Chapter
  • First Online:
Vitamin E in Human Health

Part of the book series: Nutrition and Health ((NH))

  • 1068 Accesses

Abstract

Vitamin E is a naturally occurring fat-soluble vitamin. Its antioxidant properties have made it a popular candidate to combat oxidative stress and diseases that are caused by it. It has been widely studied as a potential treatment for both primary and secondary protection of cardiovascular disease because of its well-understood mechanism, its ability to naturally recycle itself, and its promising epidemiological evidence. After numerous prospective and retrospective clinical studies, there has been a lack of consistent evidence supporting the notion that vitamin E should be used for the primary and secondary prevention of cardiovascular disease (CVD). This chapter outlines various clinical trials that have assessed the potential clinical benefit of vitamin E to prevent CVD.

Joshua Wiener and Elliot Berinstein contributed equally to this chapter.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Steinberg D, Parthasarathy S, Carew TE, Khoo JC, Witztum JL. Beyond cholesterol. Modifications of low-density lipoprotein that increase its atherogenicity. N Engl J Med. 1989;320(14):915–24. https://doi.org/10.1056/NEJM198904063201407.

    Article  CAS  PubMed  Google Scholar 

  2. Navab M, Anantharamaiah GM, Reddy ST, Van Lenten BJ, Ansell BJ, Fogelman AM. Mechanisms of disease: proatherogenic HDL – an evolving field. Nat Clin Pract Endocrinol Metab. 2006;2(9):504–11. https://doi.org/10.1038/ncpendmet0245.

    Article  CAS  PubMed  Google Scholar 

  3. Wolf G. The discovery of the antioxidant function of vitamin E: the contribution of Henry A. Mattill. J Nutr. 2005;135(3):363–6.

    Article  CAS  PubMed  Google Scholar 

  4. Burton GW, Cheng SC, Webb A, Ingold KU. Vitamin E in young and old human red blood cells. Biochim Biophys Acta. 1986;860(1):84–90.

    Article  CAS  PubMed  Google Scholar 

  5. Fahrenholtz SR, Doleiden FH, Trozzolo AM, Lamola AA. On the quenching of singlet oxygen by alpha-tocopherol. Photochem Photobiol. 1974;20(6):505–9.

    Article  CAS  PubMed  Google Scholar 

  6. Kagan VE, Serbinova EA, Forte T, Scita G, Packer L. Recycling of vitamin E in human low density lipoproteins. J Lipid Res. 1992;33(3):385–97.

    CAS  PubMed  Google Scholar 

  7. Carr AC, McCall MR, Frei B. Oxidation of LDL by myeloperoxidase and reactive nitrogen species: reaction pathways and antioxidant protection. Arterioscler Thromb Vasc Biol. 2000;20(7):1716–23.

    Article  CAS  PubMed  Google Scholar 

  8. Rimm EB, Stampfer MJ, Ascherio A, Giovannucci E, Colditz GA, Willett WC. Vitamin E consumption and the risk of coronary heart disease in men. N Engl J Med. 1993;328(20):1450–6. https://doi.org/10.1056/NEJM199305203282004.

    Article  CAS  PubMed  Google Scholar 

  9. Stampfer MJ, Hennekens CH, Manson JE, Colditz GA, Rosner B, Willett WC. Vitamin E consumption and the risk of coronary disease in women. N Engl J Med. 1993;328(20):1444–9. https://doi.org/10.1056/NEJM199305203282003.

    Article  CAS  PubMed  Google Scholar 

  10. Virtamo J, Rapola JM, Ripatti S, Heinonen OP, Taylor PR, Albanes D, et al. Effect of vitamin E and beta carotene on the incidence of primary nonfatal myocardial infarction and fatal coronary heart disease. Arch Intern Med. 1998;158(6):668–75.

    Article  CAS  PubMed  Google Scholar 

  11. de Gaetano G, Collaborative Group of the Primary Prevention Project. Low-dose aspirin and vitamin E in people at cardiovascular risk: a randomised trial in general practice. Lancet. 2001;357(9250):89–95.

    Article  PubMed  Google Scholar 

  12. Sacco M, Pellegrini F, Roncaglioni MC, Avanzini F, Tognoni G, Nicolucci A, et al. Primary prevention of cardiovascular events with low-dose aspirin and vitamin E in type 2 diabetic patients: results of the primary prevention project (PPP) trial. Diabetes Care. 2003;26(12):3264–72.

    Article  CAS  PubMed  Google Scholar 

  13. Lee IM, Cook NR, Gaziano JM, Gordon D, Ridker PM, Manson JE, et al. Vitamin E in the primary prevention of cardiovascular disease and cancer: the Women’s health study: a randomized controlled trial. JAMA. 2005;294(1):56–65. https://doi.org/10.1001/jama.294.1.56.

    Article  CAS  PubMed  Google Scholar 

  14. Chae CU, Albert CM, Moorthy MV, Lee IM, Buring JE. Vitamin E supplementation and the risk of heart failure in women. Circ Heart Fail. 2012;5(2):176–82. https://doi.org/10.1161/CIRCHEARTFAILURE.111.963793.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Sesso HD, Buring JE, Christen WG, Kurth T, Belanger C, MacFadyen J, et al. Vitamins E and C in the prevention of cardiovascular disease in men: the Physicians’ health study II randomized controlled trial. JAMA. 2008;300(18):2123–33. https://doi.org/10.1001/jama.2008.600.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Arad Y, Spadaro LA, Roth M, Newstein D, Guerci AD. Treatment of asymptomatic adults with elevated coronary calcium scores with atorvastatin, vitamin C, and vitamin E: the St. Francis Heart Study randomized clinical trial. J Am Coll Cardiol. 2005;46(1):166–72. https://doi.org/10.1016/j.jacc.2005.02.089.

    Article  CAS  PubMed  Google Scholar 

  17. Kianoush S, Mirbolouk M, Makam RC, Nasir K, Blaha MJ. Coronary artery calcium scoring in current clinical practice: how to define its value? Curr Treat Options Cardiovasc Med. 2017;19(11):85. https://doi.org/10.1007/s11936-017-0582-y.

    Article  PubMed  Google Scholar 

  18. Hodis HN, Mack WJ, LaBree L, Mahrer PR, Sevanian A, Liu CR, et al. Alpha-tocopherol supplementation in healthy individuals reduces low-density lipoprotein oxidation but not atherosclerosis: the vitamin E atherosclerosis prevention study (VEAPS). Circulation. 2002;106(12):1453–9.

    Article  CAS  PubMed  Google Scholar 

  19. Nanayakkara PW, van Guldener C, ter Wee PM, Scheffer PG, van Ittersum FJ, Twisk JW, et al. Effect of a treatment strategy consisting of pravastatin, vitamin E, and homocysteine lowering on carotid intima-media thickness, endothelial function, and renal function in patients with mild to moderate chronic kidney disease: results from the Anti-Oxidant Therapy in Chronic Renal Insufficiency (ATIC) Study. Arch Intern Med. 2007;167(12):1262–70. https://doi.org/10.1001/archinte.167.12.1262.

    Article  CAS  PubMed  Google Scholar 

  20. Alves Luzia L, Mendes Aldrighi J, Teixeira Damasceno NR, Rodrigues Sampaio G, Aparecida Manolio Soares R, Tande Silva I, et al. Fish oil and vitamin E change lipid profiles and anti-Ldl-antibodies in two different ethnic groups of women transitioning through menopause. Nutr Hosp. 2015;32(1):165–74. https://doi.org/10.3305/nh.2015.32.1.9079.

    Article  PubMed  Google Scholar 

  21. Esterbauer H, Cheeseman KH. Determination of aldehydic lipid peroxidation products: malonaldehyde and 4-hydroxynonenal. Methods Enzymol. 1990;186:407–21.

    Article  CAS  PubMed  Google Scholar 

  22. DeMaio SJ, King SB 3rd, Lembo NJ, Roubin GS, Hearn JA, Bhagavan HN, et al. Vitamin E supplementation, plasma lipids and incidence of restenosis after percutaneous transluminal coronary angioplasty (PTCA). J Am Coll Nutr. 1992;11(1):68–73.

    Article  CAS  PubMed  Google Scholar 

  23. Stephens NG, Parsons A, Schofield PM, Kelly F, Cheeseman K, Mitchinson MJ. Randomised controlled trial of vitamin E in patients with coronary disease: Cambridge Heart Antioxidant Study (CHAOS). Lancet. 1996;347(9004):781–6.

    Article  CAS  PubMed  Google Scholar 

  24. Investigators G-P. Dietary supplementation with n-3 polyunsaturated fatty acids and vitamin E after myocardial infarction: results of the GISSI-Prevenzione trial. Gruppo Italiano per lo Studio della Sopravvivenza nell’Infarto miocardico. Lancet. 1999;354(9177):447–55.

    Article  Google Scholar 

  25. Yusuf S, Dagenais G, Pogue J, Bosch J, Sleight P. Vitamin E supplementation and cardiovascular events in high-risk patients. The heart outcomes prevention evaluation study investigators. N Engl J Med. 2000;342(3):154–60. https://doi.org/10.1056/NEJM200001203420302.

    Article  CAS  PubMed  Google Scholar 

  26. Lonn E, Bosch J, Yusuf S, Sheridan P, Pogue J, Arnold JM, et al. Effects of long-term vitamin E supplementation on cardiovascular events and cancer: a randomized controlled trial. JAMA. 2005;293(11):1338–47. https://doi.org/10.1001/jama.293.11.1338.

    Article  PubMed  Google Scholar 

  27. Waters DD, Alderman EL, Hsia J, Howard BV, Cobb FR, Rogers WJ, et al. Effects of hormone replacement therapy and antioxidant vitamin supplements on coronary atherosclerosis in postmenopausal women: a randomized controlled trial. JAMA. 2002;288(19):2432–40.

    Article  CAS  PubMed  Google Scholar 

  28. Heart Protection Study Collaborative G. MRC/BHF heart protection study of antioxidant vitamin supplementation in 20,536 high-risk individuals: a randomised placebo-controlled trial. Lancet. 2002;360(9326):23–33. https://doi.org/10.1016/S0140-6736(02)09328-5.

    Article  Google Scholar 

  29. Boaz M, Smetana S, Weinstein T, Matas Z, Gafter U, Iaina A, et al. Secondary prevention with antioxidants of cardiovascular disease in endstage renal disease (SPACE): randomised placebo-controlled trial. Lancet. 2000;356(9237):1213–8.

    Article  CAS  PubMed  Google Scholar 

  30. Stenvinkel P, Heimburger O, Paultre F, Diczfalusy U, Wang T, Berglund L, et al. Strong association between malnutrition, inflammation, and atherosclerosis in chronic renal failure. Kidney Int. 1999;55(5):1899–911. https://doi.org/10.1046/j.1523-1755.1999.00422.x.

    Article  CAS  PubMed  Google Scholar 

  31. Galli F, Rovidati S, Chiarantini L, Campus G, Canestrari F, Buoncristiani U. Bioreactivity and biocompatibility of a vitamin E-modified multi-layer hemodialysis filter. Kidney Int. 1998;54(2):580–9. https://doi.org/10.1046/j.1523-1755.1998.00021.x.

    Article  CAS  PubMed  Google Scholar 

  32. Miller ER, Pastor-Barriuso R, Dalal D, Riemersma RA, Appel LJ, Guallar E. Meta-analysis: high-dosage vitamin E supplementation may increase all-cause mortality. Ann Intern Med. 2005;142(1):37–46.

    Article  CAS  PubMed  Google Scholar 

  33. Levy AP, Hochberg I, Jablonski K, Resnick HE, Lee ET, Best L, et al. Haptoglobin phenotype is an independent risk factor for cardiovascular disease in individuals with diabetes: the strong heart study. J Am Coll Cardiol. 2002;40(11):1984–90.

    Article  PubMed  Google Scholar 

  34. Roguin A, Koch W, Kastrati A, Aronson D, Schomig A, Levy AP. Haptoglobin genotype is predictive of major adverse cardiac events in the 1-year period after percutaneous transluminal coronary angioplasty in individuals with diabetes. Diabetes Care. 2003;26(9):2628–31.

    Article  PubMed  Google Scholar 

  35. Suleiman M, Aronson D, Asleh R, Kapeliovich MR, Roguin A, Meisel SR, et al. Haptoglobin polymorphism predicts 30-day mortality and heart failure in patients with diabetes and acute myocardial infarction. Diabetes. 2005;54(9):2802–6.

    Article  CAS  PubMed  Google Scholar 

  36. Blum S, Vardi M, Levy NS, Miller-Lotan R, Levy AP. The effect of vitamin E supplementation on cardiovascular risk in diabetic individuals with different haptoglobin phenotypes. Atherosclerosis. 2010;211(1):25–7. https://doi.org/10.1016/j.atherosclerosis.2010.02.018.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Levy AP, Gerstein HC, Miller-Lotan R, Ratner R, McQueen M, Lonn E, et al. The effect of vitamin E supplementation on cardiovascular risk in diabetic individuals with different haptoglobin phenotypes. Diabetes Care. 2004;27(11):2767.

    Article  PubMed  Google Scholar 

  38. Milman U, Blum S, Shapira C, Aronson D, Miller-Lotan R, Anbinder Y, et al. Vitamin E supplementation reduces cardiovascular events in a subgroup of middle-aged individuals with both type 2 diabetes mellitus and the haptoglobin 2-2 genotype: a prospective double-blinded clinical trial. Arterioscler Thromb Vasc Biol. 2008;28(2):341–7. https://doi.org/10.1161/ATVBAHA.107.153965.

    Article  CAS  PubMed  Google Scholar 

  39. Hochberg I, Berinstein EM, Milman U, Shapira C, Levy AP. Interaction between the haptoglobin genotype and vitamin E on cardiovascular disease in diabetes. Curr Diab Rep. 2017;17(6):42. https://doi.org/10.1007/s11892-017-0868-1.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Andrew P. Levy .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Wiener, J.B., Berinstein, E.M., Levy, A.P. (2019). Clinical Cardiovascular Disease Trials: The Vitamin E Case. In: Weber, P., Birringer, M., Blumberg, J., Eggersdorfer, M., Frank, J. (eds) Vitamin E in Human Health. Nutrition and Health. Humana Press, Cham. https://doi.org/10.1007/978-3-030-05315-4_20

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-05315-4_20

  • Published:

  • Publisher Name: Humana Press, Cham

  • Print ISBN: 978-3-030-05314-7

  • Online ISBN: 978-3-030-05315-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics