The role of vitamin E (tocopherol) supplementation in the prevention of stroke (original) (raw)

Thromb Haemost 2011; 105(04): 579-585
DOI: 10.1160/TH10-11-0729

Schattauer GmbH

A meta-analysis of 13 randomised controlled trials

Further Information

Publication History

Received: 15 November 2010

Accepted after major revision: 11 January 2010

Publication Date:
28 November 2017 (online)

Summary

It was the objective of this work to systematically evaluate the role of vitamin E supplementation in the prevention of stroke. Eligible studies were identified from Medline, Embase and Cochrane Library. The efficacy data is the relative risk (RR) for the events of stroke. Thirteen randomised controlled trials (RCTs), with 166,282 participants in total, were analysed. The pooled results showed no significant benefit in the vitamin E group with respect to stroke of any type (RR 1.01; 95% confidence interval [CI]: 0.96, 1.07); ischaemic stroke (RR 1.01; 95% CI: 0.94, 1.09), haemorrhagic stroke (RR 1.12; 95% CI: 0.94, 1.33), fatal stroke (RR 0.94; 95% CI: 0.77, 1.14), and non-fatal stroke (RR 0.99; 95% CI: 0.91, 1.08). Administration of vitamin E 300 IU/day or more also gain no benefit (RR 0.99; 95% CI: 0.92, 1.06), as well as vitamin E less than 300 IU (RR 1.05; 95% CI: 0.96, 1.15). Vitamin E supplementation gained benefit of preventing stroke for neither healthy people (0.92; 0.83, 1.03) nor others at high risks in baseline (RR 1.05; 95% CI: 0.98, 1.12). Administration of synthetic vitamin E gain no benefit (RR 1.02; 95% CI: 0.96, 1.09), as well as the natural source vitamin E (RR 0.99; 95% CI: 0.89, 1.09). In conclusion, there is a lack of statistically significant or clinically important benefit of vitamin E supplementation in the prevention of stroke.

Keywords

Vitamin E - stroke - meta-analysis

• References

• 1 Goldstein LB, Adams R, Becker K. et al. Primary prevention of ischemic stroke. A statement for healthcare professionals from the Stroke Council of the American Heart Association. Stroke 2001; 32: 280-299.
• 2 Gillman MW, Cupples LA, Gagnon D. et al. Protective effect of fruits and vegetables on development of stroke in men. J Am Med Assoc 1995; 273: 1113-1117.
• 3 Joshipura KJ, Ascherio A, Manson JE. et al. Fruit and vegetable intake in relation to risk of ischemic stroke. J Am Med Assoc 1999; 282: 1233-1239.
• 4 Sies H, Stahl W. Vitamins E and C, beta-carotene, and other carotenoids as anti-oxidants. Am J Clin Nutr 1995; 62: 1315-1321.
• 5 Gey KF. On the antioxidant hypothesis with regard to arteriosclerosis. Bibl Nutr Dieta 1986; 37: 53-91.
• 6 Diaz MN, Frei B, Vita JA. et al. Antioxidants and atherosclerotic heart disease. N Engl J Med 1997; 337: 408-416.
• 7 Williams JC, Forster LA, Tull SP. et al. Effects of vitamin E on human platelet and mononuclear cell responses in vitro. Int J Exp Pathol 1999; 80: 227-234.
• 8 Ascherio A, Rimm EB, Hernán MA. et al. Relation of consumption of vitamin E, vitamin C, and carotenoids to risk for stroke among men in the United States. Ann Intern Med 1999; 130: 963-970.
• 9 Vokó Z, Hollander M, Hofman A. et al. Dietary antioxidants and the risk of ischemic stroke: the Rotterdam Study. Neurology 2003; 61: 1273-1275.
• 10 Higgins JPT, Green S. (eds). Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.1 [updated September 2008]. The Cochrane Collaboration, 2008.
• 11 Sutton AJ, Abrams KR, Jones DR. Methods for Meta-analysis in Medical Research. Wiley: Chichester; 2000
• 12 Begg CB, Mazumdar M. Operating characteristics of a rank correlation test for publication bias. Biometrics 1994; 50: 1088-1101.
• 13 Egger M, Davey Smith G, Schneider M. et al. Bias in meta-analysis detected by a simple, graphical test. Br Med J 1997; 315: 629-634.
• 14 Sesso HD, Buring JE, Christen WG. et al. Vitamins E and C in the prevention of cardiovascular disease in men: the Physicians’ Health Study II randomized controlled trial. J Am Med Assoc 2008; 300: 2123-2133.
• 15 Cook NR, Albert CM, Gaziano JM. et al. A randomized factorial trial of vitamins C and E and beta carotene in the secondary prevention of cardiovascular events in women: results from the Women’s Antioxidant Cardiovascular Study. Arch Intern Med 2007; 167: 1610-1618.
• 16 Lee IM, Cook NR, Gaziano JM. et al. Vitamin E in the primary prevention of cardiovascular disease and cancer: the Women‘s Health Study: a randomized controlled trial. J Am Med Assoc 2005; 294: 56-65.
• 17 Li JY, Taylor PR, Li B. et al. Nutrition intervention trials in Linaxin, China: Multiple vitamin/mineral supplementation, cancer incidence, and disease specific mortality among adults with esophageal dysplasia. J Natl Cancer Inst 1993; 85: 1483-1492.
• 18 Milman U, Blum S, Shapira C. et al. Vitamin E supplementation reduces cardiovascular events in a subgroup of middle-aged individuals with both type 2 diabetes mellitus and the haptoglobin 2–2 genotype: a prospective double-blinded clinical trial. Arterioscler Thromb Vasc Biol 2008; 28: 341-347.
• 19 Lonn E, Bosch J, Yusuf S. et al. Effects of long-term vitamin E supplementation on cardiovascular events and cancer: a randomized controlled trial. J Am Med Assoc 2005; 293: 1338-1347.
• 20 Törnwall ME, Virtamo J, Korhonen PA. et al. Postintervention effect of alpha tocopherol and beta carotene on different strokes: a 6-year follow-up of the Alpha Tocopherol, Beta Carotene Cancer Prevention Study. Stroke 2004; 35: 1908-1913.
• 21 Heart Protection Study Collaborative Group.. MRC/BHF Heart Protection Study of antioxidant vitamin supplementation in 20 536 high-risk individuals: a randomised placebocontrolled trial. Lancet 2002; 360: 23-33.
• 22 Collaborative Group of the Primary Prevention Project (PPP).. Low-dose aspirin and vitamin E in people at cardiovascular risk: a randomized trial in general practice. Lancet 2001; 357: 89-95.
• 23 Boaz M, Smetana S, Weinstein T. et al. Secondary prevention with antioxidants of cardiovascular disease in endstage disease (SPACE): randomized placebo-controlled trial. Lancet 2000; 356: 1213-1218.
• 24 GISSI- Prevention Investigators.. Dietary supplementation with n-3 polyunsatu-rated fatty acids and vitamin E after myocardial infarction: results of the GISSI-prevention trial. Lancet 1999; 354: 447-455.
• 25 Stephens NG, Parson A, Schofield PM. Randomized controlled trial of vitamin E in patients with coronary disease: Cambridge Heart Antioxidant Study (CHAOS 1996). Lancet 1996; 347: 781-786.
• 26 Steiner M, Glantz M, Lekos A. Vitamin E plus aspirin compared with aspirin alone in patients with transient ischemic attacks. Am J Clin Nutr 1995; 62: 1381-1384.
• 27 Steinberg D. Clinical trials of antioxidants in atherosclerosis: are we doing the right thing?. Lancet 1995; 346: 36-38.
• 28 Meagher EA, Barry OP, Lawson JA. et al. Effects of vitamin E on lipid peroxidation in healthy persons. J Am Med Assoc 2001; 285: 1178-1182.
• 29 Devaraj S, Jialel I. Failure of vitamin E in clinical trials: is gamma-tocopherol the answer?. Nutr Rev 2005; 63: 290-293.
• 30 Schürks M, Glynn RJ, Rist PM. et al. Effects of vitamin E on stroke subtypes: meta-analysis of randomised controlled trials. Br Med J 2010; 341: c5702.
• 31 Steiner M. Influence of vitamin E on platelet function in humans. J Am Coll Nutr 1991; 10: 466-473.
• 32 Colette C, Pares-Herbute N, Monnier LH. et al. Platelet function in type?Tdiabetes: effects of supplementation with large doses of vitamin E. Am J Clin Nutr 1988; 47: 256-261.
• 33 Hankey GJ. Preventable stroke and stroke prevention. J Thromb Haemost 2005; 3: 1638-1645.
• 34 Miller 3rd ER, Pastor-Barriuso R, Dalal D. et al. Meta-analysis: high-dosage vitamin E supplementation may increase all-cause mortality. Ann Intern Med 2005; 142: 37-46.
• 35 Mente A, de Koning L, Shannon HS. et al. A systematic review of the evidence supporting a causal link between dietary factors and coronary heart disease. Arch Intern Med 2009; 169: 659-669.