Ishwarlal Jialal, MD, PhD; Sridevi Devaraj, PhD
Potential Financial Conflicts of Interest: None disclosed.
Jialal I, Devaraj S. High-Dosage Vitamin E Supplementation and All-Cause Mortality. Ann Intern Med. 2005;143:155. doi: 10.7326/0003-4819-143-2-200507190-00026
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Published: Ann Intern Med. 2005;143(2):155.
TO THE EDITOR:
We read with interest the statistically questionable and selective meta-analysis by Miller and colleagues (1). Because of their arbitrary exclusion criteria, they omitted 2 studies that clearly showed the benefit of combined RRR-α-tocopherol and vitamin C supplementation on the primary end point: the Antioxidant Supplementation in Atherosclerosis Prevention (ASAP) study, which involved 440 hypercholesterolemic patients followed up for 6 years (2), and the Transplant-Associated Arteriosclerosis Study (3).
Also, of the 11 studies that Miller and colleagues suggested show harm from high-dose vitamin E supplementation, 5 used vitamin E along with other antioxidants, including β-carotene, which has previously been shown to be harmful (2). In Miller and colleagues' Figure 2, there does not appear to be a dose response between high-dose vitamin E and mortality; in fact, there was a trend toward benefit in ADCS (2000 IU of vitamin E per day). Furthermore, in 3 of these 11 studies that used vitamin E alone (Cambridge Heart Antioxidant Study [CHAOS], Secondary Prevention with Antioxidants of Cardiovascular disease in Endstage renal disease [SPACE] Study, and ADCS), there was a significant benefit on the primary end point without a significant increase in mortality (2, 3).
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