Vitamin E and coronary artery disease

Various studies have evaluated the antioxidant effects of vitamin E in the prevention or treatment of coronary artery disease (CAD). In vitro data sug gest that vitamin E protects against oxidation of low-density lipoprotein a nd decreases the deposition of atherogenic oxidized low-density lipoprotein in arterial walls. Various observational and epidemiological studies also suggest a relationship between vitamin E serum concentrations or intake and CAD. One prospective, randomized trial suggested that low-dosage vitamin E supplementation (50 IU/d) decreases the risk of angina in patients without previously diagnosed CAD. Another study, using high-dosage vitamin E suppl ementation (400 or 800 IU/d), demonstrated a decrease in the combined end p oint of nonfatal myocardial infarction and cardiovascular death in patients with established CAD. Discordant data, however, have been published that i mply no cardiovascular benefit of low-dosage vitamin E supplementation (50 IU/d) and detrimental effects if vitamin E is combined with beta carotene. At this point, clinicians should emphasize a low-fat diet with high intake of fruits and vegetable sources containing vitamin E. Supplemental vitamin E may be considered in patients at high risk for CAD or with documented CAD , but the potential beneficial effects should be weighed against possible l ong-term adverse effects. If vitamin E supplementation is initiated, the li terature suggests dosages of 100 to 400 IU/d, with the higher dosage consid ered in patients with documented CAD. Additional investigation is warranted to further define the role of vitamin E supplementation in CAD and to crit ically evaluate the optimal dosage, duration of use, and method of consumpt ion (dietary vs supplemental).