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Bid farewell
to an old but unhelpful friend
(This article was first printed in the June
2005 issue of the Harvard Heart Letter.
For more information or to order, please go
to www.health.harvard.edu/heart.)
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.
Foods for a healthier
heart
Eating foods rich in vitamin E will do
a lot more for your heart, and the rest
of you, than popping a pill loaded with
it. Good food sources of vitamin E include:
- Some whole-grain breakfast cereals
- Sunflower seeds
- Almonds, hazelnuts, and peanuts
- Spinach and turnip greens
- Sunflower or safflower oil
- Tomato sauce
- Red and green peppers
- Sweet potatoes
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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.
(This article was first printed in the June
2005 issue of the Harvard Heart Letter.
For more information or to order, please go
to www.health.harvard.edu/heart.)
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