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Editorials |19 July 2005

An Editorial Update: Annus horribilis for Vitamin E

Eliseo Guallar, MD, DrPH; Daniel F. Hanley, MD; Edgar R. Miller III, MD, PhD

Article, Author, and Disclosure Information
Author, Article, and Disclosure Information
  • From Johns Hopkins University Bloomberg School of Public Health, Johns Hopkins Medical Institutions, Baltimore, MD 21205.

    Potential Financial Conflicts of Interest: None disclosed.

    Requests for Single Reprints: Eliseo Guallar, MD, DrPH, Department of Epidemiology, Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, 2024 East Monument Street, Room 2-639, Baltimore, MD 21205; e-mail, eguallar@jhsph.edu.

    Current Author Addresses: Dr. Guallar, Department of Epidemiology, Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, 2024 E. Monument St., Room 2-639, Baltimore, MD 21205.

    Dr. Hanley: Brain Injury Outcomes Division, Department of Neurology, Johns Hopkins Medical Institutions, Jefferson 1-109, 600 North Wolfe Street, Baltimore, MD 21205.

    Dr. Miller: Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, and Division of General Internal Medicine, Department of Medicine, Johns Hopkins Medical Institutions, 2024 E. Monument St., Room 2-624, Baltimore, MD 21205.

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In January 2005, we published a dose–response meta-analysis showing that high-dosage (≥400 IU/d) vitamin E supplementation was associated with a small but statistically significant increased risk for mortality (relative risk, 1.04 [95% CI, 1.01 to 1.07]) (1). The precise dosage of vitamin E at which the relative risk for mortality exceeded 1 and the magnitude of the risk increase were uncertain. However, the analysis showed that high-dosage vitamin E supplementation was likely to be harmful. Even in the best case, it offered no benefit in prolonging life. These findings were highly controversial: Together with our response, this issue of Annals includes 11 of more than 40 electronic rapid responses to the Annals Web site. Rather than summarizing this exchange of views, this editorial reports further developments in the vitamin E story.
Recently, vitamin E has suffered several setbacks. The Women's Health Study (WHS), a 10-year, primary prevention trial that randomly assigned 39 876 healthy women to either 600 IU of vitamin E or placebo on alternate days, found that vitamin E did not reduce cardiovascular disease or cancer (2). Indeed, total mortality was slightly—although nonsignificantly—increased with vitamin E (relative risk, 1.04 [CI, 0.93 to 1.16]). The WHS was particularly important since its target population, healthy women, was underrepresented in the trials included in our meta-analysis.
The Heart Outcomes Prevention Evaluation–The Ongoing Outcomes (HOPE-TOO) study recently reported its findings (3). This report extended the follow-up of the original HOPE trial (4), in which...
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Guallar E, Hanley DF, Miller ER. An Editorial Update: Annus horribilis for Vitamin E. Ann Intern Med. 2005;143:143–145. doi: 10.7326/0003-4819-143-2-200507190-00014

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Published: Ann Intern Med. 2005;143(2):143-145.

DOI: 10.7326/0003-4819-143-2-200507190-00014

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2005 American College of Physicians
36 Citations

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