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(Arteriosclerosis, Thrombosis, and Vascular Biology. 2009;29:1304.)
© 2009 American Heart Association, Inc.

National Cholesterol Awareness Month

Decision Analysis Supports the Paradigm That Indiscriminate Supplementation of Vitamin E Does More Harm than Good

Yedidya Dotan; Ilya Pinchuk; Dov Lichtenberg; Moshe Leshno

From the Department of Physiology and Pharmacology (Y.D., I.P., D.L.) and the Faculty of Management and School of Medicine (M.L.), Tel Aviv University, Sackler Faculty of Medicine, Israel.

Correspondence to Prof. Dov Lichtenberg, the Department of Physiology and Pharmacology, Tel Aviv University, Sackler Faculty of Medicine, Ramat Aviv, Tel Aviv 69978, Israel. E-mail physidov{at}post.tau.ac.il

Abstract

Objectives— For many years, the prevailing concept was that LDL oxidation plays a central role in atherogenesis. As a consequence, supplementation of antioxidants, particularly vitamin E, became very popular. Unfortunately, however, the major randomized clinical trials have yielded disappointing results on the effects of vitamin E on both mortality and morbidity. Moreover, recent meta-analyses have concluded that vitamin E supplementation increases mortality. This conclusion has raised much criticism, most of it relating to three issues: (1) the choice of clinical trials to be included in the meta-analyses; (2) the end point of these meta-analyses (only mortality); and (3) the heterogeneity of the analyzed clinical trials with respect to both population and treatment. Our goal was to bring this controversy to an end by using a Markov-model approach, which is free of most of the limitations involved in using meta-analyses.

Methods and Results— We used a Markov model to compare the vitamin E supplemented virtual cohorts with nonsupplemented cohorts derived from published randomized clinical trials that were included in at least one of the major meta-analyses. The difference between the virtual supplemented and nonsupplemented cohorts is given in terms of a composite end point denoted quality-adjusted life year (QALY). The vitamin E supplemented virtual cohort had 0.30 QALY (95%CI 0.21 to 0.39) less than the nontreated virtual cohort.

Conclusions— Our study demonstrates that in terms of QALY, indiscriminate supplementation of high doses of vitamin E is not beneficial in preventing CVD. Selective supplementation of vitamin E to individuals under oxidative stress requires further investigation.

Our objective was to reassess the outcome of nondiscriminatory supplementation of vitamin E with respect to its effects on cardiovascular-related events and mortality. Our analysis, applying a Markov model, revealed that supplementing the general public with vitamin E results in loss of quality-adjusted life years.

Key Words: CVD • oxidative stress • vitamin E • decision analysis • Markov model

eLetters:

Read all eLetters

Vitamin E may increase and decrease mortality

Harri Hemilä

ATVB Online, 15 Oct 2009 [Full text]

Re: Vitamin E may increase and decrease mortality

Dov Lichtenberg, et al.

ATVB Online, 2 Nov 2009 [Full text]