Bid farewell to an old but unhelpful friend

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Bid farewell to an old but unhelpful friend

It’s time to face the facts: Vitamin E won’t protect you from a heart attack or stroke.

A superstar’s fall from grace is never pretty. When that superstar is vitamin E, there’s also some exasperation.

Oh E, how could you do this to us? We took you for years, trusting you to protect our hearts. And you repay us with nothing!

Nothing is the long and the short of it. Vitamin E won’t protect you from a heart attack or stroke. There’s no need to hold out for that next big study — recent research (below) puts to rest the last niggling questions.

It’s time to let E go.

No benefit if you’re healthy…

The Harvard-based Women’s Health Study should really be the last word on vitamin E and heart disease. It included almost 40,000 middle-aged women. Half took a capsule containing 600 international units (IU) of vitamin E every other day; the other half took an identical placebo capsule. This trial used so-called natural source vitamin E, a mixture of all eight forms of the vitamin. Most other trials used synthetic versions of just one form, alpha-tocopherol.

Over the 10-year study, the number of heart attacks, strokes, or other major cardiovascular events were virtually the same in the vitamin E and placebo groups. In other words, vitamin E didn’t protect the heart any better than a sugar pill. The results were published in the March 31, 2005, New England Journal of Medicine.

A few months earlier, a seven-year French study of 13,000 healthy men and women found much the same thing. Among those who took a daily pill that included low-dose vitamin E, heart attacks and strokes were just as common in the vitamin E group as in the placebo group.

…or if you have heart disease

For people who already have heart disease, vitamin E is equally unhelpful, with nary a glimmer of protection seen in studies. One study, called HOPE-TOO, included 7,000 men and women with heart disease, peripheral artery disease, a prior stroke, or diabetes. They took either 400 IU of synthetic vitamin E (alpha-tocopherol) or a placebo for seven years. Heart attacks, strokes, and heart-related deaths were just as common in the vitamin E group as in the placebo group.

Red flags

You might be thinking, vitamin E doesn’t help but it doesn’t hurt, either. That’s probably true, though three studies raise red flags about whether it is truly harmless.

Heart failure. In HOPE-TOO, 5.8% of those taking vitamin E were hospitalized for heart failure, compared with 4.2% of those taking a placebo.

HDL interference. In one small clinical trial testing the combined effect of niacin, a cholesterol-lowering statin, and vitamin E, the vitamin canceled out the increase in heart protective HDL (good) cholesterol that would normally appear with the use of the other two drugs.

Mortality. An analysis of 19 vitamin E trials showed that use of high doses (above 400 IU) slightly increased the chances of dying.

The heart failure and HDL problems were seen only in single studies, so they could be flukes. In the mortality analysis, many of the studies included volunteers with heart disease, cancer, or some other chronic condition, so it isn’t certain if vitamin E is to blame. No such hazard was seen in the Women’s Health Study or the French trial.

Still, even the hint of trouble is reason enough to lay off something that offers little or no proven benefit.

Moving on

Harvard health policy expert Robert Blendon and his colleagues have examined Americans’ attitudes toward the use of vitamins and other dietary supplements. Here is one of their conclusions: “Many users feel so strongly about the potential health benefits of some of these products that they reported that they would continue to take them even if they were shown to be ineffective in scientifically conducted clinical studies.”

That will probably be true for vitamin E, especially since we keep hearing about potential new uses. It is being tested for dozens of conditions, notably prostate cancer, Alzheimer’s disease, and macular degeneration.

If you take a vitamin E supplement, think about weaning yourself from it. Take it every other day for a few weeks, then twice a week, then stop. If you just don’t want to give it up, at least tell your doctor you are taking it. And please don’t make the mistake of thinking it will protect you against heart disease. Give the proven therapies — a healthier diet, more exercise, aspirin, statins, beta blockers, ACE inhibitors, and others — the same loyalty you give your vitamin E.

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Last updated:	August 21, 2006