Harri Hemilä, MD, PhD
Disclosures: None. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L14-0083.
Hemilä H. Vitamin and Mineral Supplements in the Primary Prevention of Cardiovascular Disease and Cancer. Ann Intern Med. 2014;160:655. doi: 10.7326/L14-5009-3
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Published: Ann Intern Med. 2014;160(9):655.
TO THE EDITOR:
Fortmann and colleagues (1) calculated that vitamin E supplementation does not influence all-cause mortality (95% CI, −2% to 4%). This estimate was based on the pooling of the results of 5 studies. However, conclusions of study-level analyses can differ from those of corresponding individual-level analysis, a difference known as the “ecological fallacy” (2).
Recently, a colleague and I analyzed heterogeneity in the effect of vitamin E on the mortality of participants in the ATBC (Alpha-Tocopherol, Beta-Carotene) study, who were male smokers aged 50 to 69 years at baseline (3). The combination of age and dietary vitamin C intake modified the effect of vitamin E supplementation so that the heterogeneity over 6 subgroups was highly significant (P < 0.001).
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