Vitamin E and the Heart

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Vitamin E is an antioxidant found in vegetable oil, wheat germ, leafy vegetables, egg yolks, margarine, and legumes (beans).

A number of recent studies have attempted to determine whether taking vitamin E supplements lowers the risk of atherosclerotic heart disease and heart attacks by inhibiting low-density lipoprotein (LDL, the bad type of cholesterol). In the early 1990s, three studies found no correlation between the naturally occurring level of vitamin E in the blood and heart attacks or cardiovascular deaths. In a randomized, double-blind study, a relatively low dose of vitamin E was tested for lung cancer prevention effects. No effect on cardiovascular mortality was found.

Subsequently, the British conducted a study known as the Cambridge Heart

Anti-Oxidant Study (CHAOS). One thousand thirty-five patients were assigned to receive vitamin E in relatively large doses (400 to 800 IU), and 960 patients received an identical placebo. All of the patients in the study had coronary atherosclerosis proven by coronary angiogram. The patients were studied for about eighteen months.

There were fourteen nonfatal heart attacks in the group receiving vitamin E and forty-one in the placebo group. However, there were actually more cardiovascular deaths in the vitamin E group (twenty-seven versus twenty-three). The authors published their paper in the prestigious British medical journal Lancet in 1996 and concluded that vitamin E supplements substantially reduced the rate of nonfatal heart attacks.

More recently, the August 7, 1999, issue of Lancet contained an article by a group of Italian doctors who reported their findings about vitamin E in a group of 11,324 patients. All of their patients had suffered heart attacks and were randomized to receive vitamin E and/or another drug or no drug treatment. The patients were studied for about three and a half years. When the doctors compared the group that had been treated with vitamin E against those patients who had been given no treatment, they could find no cardiovascular benefit in the vitamin E-sup-plemented group.

In another recent Lancet article, Drs. Andy Ness and George Davey-Smith reviewed updated CHAOS data as well as information from a number of other published trials with vitamin E supplements and concluded, "On the basis of all available data, we believe that vitamin E supplements cannot be recommended for patients with coronary heart disease."

In that same issue, Dr. Malcolm J. Mitchinson, on behalf of the CHAOS investigators, replied to Ness and Davey-Smith with the comment, "Their facts seem substantially correct." He went on to state, "No

Statins:

A group of lipid-lowering drugs.

High-Density Lipoprotein:

This is known as the good type of cholesterol. A higher HDL level is good and indicates one is less likely to suffer a heart attack.

Coronary Angiogram:

An x-ray movie of a coronary artery.

Light exercise like bike riding is recommended for both heart patients and people with no heart disease. It is recommended that people exercise at least three times a week for twenty minutes per session.

one would dissent from the express conclusion that CHAOS alone cannot justify a policy of prophylactic supplementation by vitamin E."

Nonetheless, Mitchinson remains optimistic about vitamin E and its potential cardiac health benefits, and he thinks that cardiovascular benefits will eventually be shown with longer follow-up of the CHAOS patients.

The bottom line is that vitamin E is an extremely important vitamin, and we can't live without it. At this point, however, studies of the use of vitamin E supplements to prevent or lessen the effects of cardiovascular disease have not decisively shown a benefit.

However, more studies are underway, and people who are considering taking vitamin E should check with their healthcare professionals, who are continually updated on this research through medical journals and national meetings.

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