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Vitamin E and C supplementation had no effect on major CV events
Physicians Health Study II closes the door on vitamins E and C supplementation for staving off CVD.
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Results of the Physicians Health Study II have found that vitamin E and vitamin C supplementation had no effect on cardiovascular events when compared with placebo. Investigators involved in the study have concluded that the use of vitamins E and C have no place in a comprehensive CVD prevention strategy.
The Physicians Health Study II was a randomized, double-blind, placebo-controlled, factorial design trial. It aimed to determine the cancer and cardiovascular disease benefits of 400 IU of vitamin E, 500 IU of vitamin C, and a multivitamin taken every other day. The study population comprised 14,641 male physicians aged 50 or older, 5.1% of whom had prevalent cardiovascular disease at randomization.
After an average of eight years of follow up, the rates of major cardiovascular events (including MI death, stroke death, ischemic stroke and cardiovascular death) were similar between the vitamin E and placebo groups, as were the rates of congestive heart failure, angina, revascularization and total mortality. Only hemorrhagic stroke was significantly different between the groups, with an increase in risk in those assigned to vitamin E supplementation (HR=1.74; 95% CI, 1.04-2.91).
In the group assigned to vitamin C supplementation, there were no significant differences between vitamin C and placebo in any of the outcomes measured.
J. Michael Gaziano, MD, MPH, chief of the Division of Aging, Department of Medicine at Brigham and Women's Hospital, presented the results of the study during a late-breaking session.
Further comments
"The door is closing on vitamin E and C supplementation," said Barbara V. Howard, PhD. Howard is a senior scientist at MedStar Research Institute in Hyattsville, Md., and spoke in a comment session after Gaziano's presentation.
Howard said that the increase in hemorrhagic stroke with vitamin E supplementation warrants further investigation.
She also stressed the importance of observational data vs. clinical trials in nutritional research. "There were a myriad of observational studies and even small trials showing that vitamin E improves some aspect of vascular tone, and all suggested it would be beneficial," Howard said.
"People don't eat a single nutrient, they eat foods, and these foods are part of an overall diet. Generally, people who eat a healthier diet are people who follow a healthier lifestyle in ways we can't measure, and in addition probably have better access to health care. So it's very hard to make conclusions about nutrition in observational data, and we need more trials. This take-home message should apply then to all other products out there that are claiming antioxidant benefit. ... We do not have long-term trials on any of these [products]," Howard said.