Vitamin E: HOPE or HOPE-less?

The HOPE study, published in January in The New England Journal of Medicine, found no benefit of vitamin E supplementation in heart disease patients. This trial enrolled 9,541 men and women 55 years of age or older who had heart disease or diabetes in addition to one other risk factor for heart disease. Half of the subjects got 400 IU of natural source vitamin E and half got a placebo for a period of 4.5 years. The patients were widely distributed around the world (i.e. dietary factors were not well controlled). Vitamin E had no significant effect on either primary outcomes (myocardial infarction, stroke, or death from heart disease) or secondary outcomes (angina, heart failure, claudication, limb amputation, etc.). The study appears to have been designed to assess the role of vitamin E in preventing these outcomes in high-risk patients rather than to evaluate the protective effect of the long-term intake of vitamin E against the development of heart disease in healthy people.

Many of the centers participating in the HOPE trial are in Canada, where canola oil (also known as rapeseed oil) is widely consumed. Canola oil is rich in alpha-linolenic acid, an n-3 fatty acid whose consumption is associated with decreased cardiac mortality in heart disease patients, probably due to its effects on platelet aggregation and ventricular fibrillation. Therefore, the Canadian patients who got the placebo may have enjoyed some protection from the dietary consumption of linolenic acid, thus lessening the outcome difference between that group and the group supplemented with vitamin E.

Further confounding the results, many of the HOPE subjects took various medications, and some took "non-trial" vitamin E in unspecified amounts. No measurements of the subjects' oxidative stress status were reported, nor were plasma vitamin E levels measured to ensure compliance. Unfortunately, this trial does not help us understand the role of vitamin E in preventing heart disease.

For information on vitamin E, see the Linus Pauling Institute's Micronutrient Information Center.

Last updated May, 2000

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