Vitamin E Supplementation and Cardiovascular Events in High-Risk Patients
Open accessAbstract
BACKGROUND: Observational and experimental studies suggest that the amount of vitamin E ingested in food and in supplements is associated with a lower risk of coronary heart disease and atherosclerosis. METHODS: We enrolled a total of 2545 women and 6996 men 55 years of age or older who were at high risk for cardiovascular events because they had cardiovascular disease or diabetes in addition to one other risk factor. These patients were randomly assigned according to a two-by-two factorial design to receive either 400 IU of vitamin E daily from natural sources or matching placebo and either an angiotensin-converting-enzyme inhibitor (ramipril) or matching placebo for a mean of 4.5 years (the results of the comparison of ramipril and placebo are reported in a companion article). The primary outcome was a composite of myocardial infarction, stroke, and death from cardiovascular causes. The secondary outcomes included unstable angina, congestive heart failure, revascularization or amputation, death from any cause, complications of diabetes, and cancer. RESULTS: A total of 772 of the 4761 patients assigned to vitamin E (16.2 percent) and 739 of the 4780 assigned to placebo (15.5 percent) had a primary outcome event (relative risk, 1.05; 95 percent confidence interval, 0.95 to 1.16; P=0.33). There were no significant differences in the numbers of deaths from cardiovascular causes (342 of those assigned to vitamin E vs. 328 of those assigned to placebo; relative risk, 1.05; 95 percent confidence interval, 0.90 to 1.22), myocardial infarction (532 vs. 524; relative risk, 1.02; 95 percent confidence interval, 0.90 to 1.15), or stroke (209 vs. 180; relative risk, 1.17; 95 percent confidence interval, 0.95 to 1.42). There were also no significant differences in the incidence of secondary cardiovascular outcomes or in death from any cause. There were no significant adverse effects of vitamin E. CONCLUSIONS: In patients at high risk for cardiovascular events, treatment with vitamin E for a mean of 4.5 years had no apparent effect on cardiovascular outcomes.
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The HOPE trial failed.
“Contrary to CHAOS, the HOPE trial failed (Yusuf et al. 2000)”
From Reactive Oxygen Species, Toxicity, Oxidative Stress, and Antioxidants: Chronic Diseases and Aging (2023) · cites this paper as Yusuf et al. 2000
Therapeutic use of CoQ10 and other antioxidants in vivo, particularly in human studies directed at vascular events, has been disappointing.
“However, the therapeutic use of CoQ10 and other antioxidants in vivo, particularly in human studies directed at vascular events, has been disappointing (341, 345).”
From Mitochondrial Dysfunction in Diabetes: From Molecular Mechanisms to Functional Significance and Therapeutic Opportunities (2010) · cites this paper as [345]
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- Authors
- The Heart Outcomes Prevention Evaluation Study Investigators
- Affiliations
- Hamilton General Hospital (CA)
- Corresponding author
- The Heart Outcomes Prevention Evaluation Study Investigators
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2000-01-20
- Volume
- 342
- Issue
- 3
- Pages
- 154-160
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W113714250
- Cited by
- 1,957
- References
- 26
- Citations by year
- 2026: 21 · 2025: 21 · 2024: 28 · 2023: 26 · 2022: 25 · 2021: 33 · 2020: 45 · 2019: 37 · 2018: 31 · 2017: 48 · 2016: 45 · 2015: 42 · 2014: 67 · 2013: 62 · 2012: 95
- FWCI
- 126.70
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Research Publications (Maastricht University) (submittedVersion, other-oa)
- Topics
- Health Sciences › Medicine › Biochemistry › Antioxidant Activity and Oxidative Stress
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
- Keywords
- vitamin E supplementation, cardiovascular disease, myocardial infarction, stroke, cardiovascular mortality, high-risk patients, diabetes mellitus, ramipril, ACE inhibitors, coronary artery disease, atherosclerosis, older adults
- MeSH terms
- Aged, Cardiovascular Diseases, Diabetes Mellitus, Double-Blind Method, Female, Humans, Male, Middle Aged, Mortality, Myocardial Infarction, Risk Factors, Vitamin E, Incidence, Treatment Failure, Stroke, Diabetes Complications
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