Supplemental Vitamin E (100 IU to 1200 IU/day) alone, or in combination with other antioxidants, has not been shown to have a favorable or unfavorable effect serum lipids.

• Grade I means there is Good/Strong evidence supporting the statement;
• Grade II is Fair;
• Grade III is Limited/Weak;
• Grade IV is Expert Opinion Only;
• Grade V is Not Assignable.
• High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
• Moderate (B) means we are moderately confident in the effect estimate;
• Low (C) means our confidence in the effect estimate is limited;
• Very Low (D) means we have very little confidence in the effect estimate.
• Ungraded means a grade is not assignable.

Supplemental Vitamin E, given in both natural and synthetic forms, in doses between 30-600 mg/day or 400-800 IU/day, alone or in combination with other antioxidants, has not been shown to decrease the risk for all cause mortality, cardiovascular death, fatal or nonfatal MI. Doses at this level have not been shown to cause harm.

• Grade I means there is Good/Strong evidence supporting the statement;
• Grade II is Fair;
• Grade III is Limited/Weak;
• Grade IV is Expert Opinion Only;
• Grade V is Not Assignable.
• High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
• Moderate (B) means we are moderately confident in the effect estimate;
• Low (C) means our confidence in the effect estimate is limited;
• Very Low (D) means we have very little confidence in the effect estimate.
• Ungraded means a grade is not assignable.

Supplemental vitamin E given both in natural and synthetic forms does not decrease the incidence of non-fatal MI or stroke in patients with and without a history of CVD. Study doses varied and were reported to be between 30mg and 1,000mg per day or 400 IU to 3,200 IU per day.

*For information on converting mg to IU, see Vitamin E Equivalents.

• Grade I means there is Good/Strong evidence supporting the statement;
• Grade II is Fair;
• Grade III is Limited/Weak;
• Grade IV is Expert Opinion Only;
• Grade V is Not Assignable.
• High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
• Moderate (B) means we are moderately confident in the effect estimate;
• Low (C) means our confidence in the effect estimate is limited;
• Very Low (D) means we have very little confidence in the effect estimate.
• Ungraded means a grade is not assignable.

One positive quality RCT found supplementation with high-dose multiple antioxidants vitamin C (6100 mg/day), vitamin E (1050 mg/day) and synthetic beta carotene (60 mg/day) did not significantly influence response to treatment, survival, survival time and toxicity in patients receiving chemotherapy (paclitaxel and carboplatin) for advanced stage (IIIb and IV) non-small-cell lung cancer.

• Grade I means there is Good/Strong evidence supporting the statement;
• Grade II is Fair;
• Grade III is Limited/Weak;
• Grade IV is Expert Opinion Only;
• Grade V is Not Assignable.
• High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
• Moderate (B) means we are moderately confident in the effect estimate;
• Low (C) means our confidence in the effect estimate is limited;
• Very Low (D) means we have very little confidence in the effect estimate.
• Ungraded means a grade is not assignable.

Epidemiological data suggest that intake of foods rich in Vitamin E, C and B-carotene (dietary antioxidants) as part of a cardioprotective dietary pattern have been associated with decreased risk for coronary heart disease.

• Grade I means there is Good/Strong evidence supporting the statement;
• Grade II is Fair;
• Grade III is Limited/Weak;
• Grade IV is Expert Opinion Only;
• Grade V is Not Assignable.
• High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
• Moderate (B) means we are moderately confident in the effect estimate;
• Low (C) means our confidence in the effect estimate is limited;
• Very Low (D) means we have very little confidence in the effect estimate.
• Ungraded means a grade is not assignable.

Supplemental Vitamin C and E, Beta-carotene, and Selenium should not be taken with Simvastatin-Niacin drug combination because the combination of these antioxidants may lower HDL₂-C, a beneficial subfraction of HDL-C.

• Grade I means there is Good/Strong evidence supporting the statement;
• Grade II is Fair;
• Grade III is Limited/Weak;
• Grade IV is Expert Opinion Only;
• Grade V is Not Assignable.
• High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
• Moderate (B) means we are moderately confident in the effect estimate;
• Low (C) means our confidence in the effect estimate is limited;
• Very Low (D) means we have very little confidence in the effect estimate.
• Ungraded means a grade is not assignable.

Supplemental vitamin E given both in natural and synthetic forms does not decrease the risk of cardiovascular death due to MI or stroke in patients with and without a history of CVD. Study doses varied and were reported to be between 30 mg and 1,000 mg per day or 400 IU to 3,200 IU per day. 

*For information on converting mg to IU, see Vitamin E Equivalents.

• Grade I means there is Good/Strong evidence supporting the statement;
• Grade II is Fair;
• Grade III is Limited/Weak;
• Grade IV is Expert Opinion Only;
• Grade V is Not Assignable.
• High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
• Moderate (B) means we are moderately confident in the effect estimate;
• Low (C) means our confidence in the effect estimate is limited;
• Very Low (D) means we have very little confidence in the effect estimate.
• Ungraded means a grade is not assignable.

Supplemental Vitamin E (100 IU to 1200 IU/day) alone, or in combination with other antioxidants, has not been shown to have a favorable or unfavorable effect serum lipids.

• Grade I means there is Good/Strong evidence supporting the statement;
• Grade II is Fair;
• Grade III is Limited/Weak;
• Grade IV is Expert Opinion Only;
• Grade V is Not Assignable.
• High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
• Moderate (B) means we are moderately confident in the effect estimate;
• Low (C) means our confidence in the effect estimate is limited;
• Very Low (D) means we have very little confidence in the effect estimate.
• Ungraded means a grade is not assignable.

Supplemental Vitamin E, given in both natural and synthetic forms, in doses between 30-600 mg/day or 400-800 IU/day, alone or in combination with other antioxidants, has not been shown to decrease the risk for all cause mortality, cardiovascular death, fatal or nonfatal MI. Doses at this level have not been shown to cause harm.

• Grade I means there is Good/Strong evidence supporting the statement;
• Grade II is Fair;
• Grade III is Limited/Weak;
• Grade IV is Expert Opinion Only;
• Grade V is Not Assignable.
• High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
• Moderate (B) means we are moderately confident in the effect estimate;
• Low (C) means our confidence in the effect estimate is limited;
• Very Low (D) means we have very little confidence in the effect estimate.
• Ungraded means a grade is not assignable.

Six studies investigating the effect of vitamin E on blood pressure report inconclusive findings.

• Grade I means there is Good/Strong evidence supporting the statement;
• Grade II is Fair;
• Grade III is Limited/Weak;
• Grade IV is Expert Opinion Only;
• Grade V is Not Assignable.
• High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
• Moderate (B) means we are moderately confident in the effect estimate;
• Low (C) means our confidence in the effect estimate is limited;
• Very Low (D) means we have very little confidence in the effect estimate.
• Ungraded means a grade is not assignable.

Results of one randomized controlled trial of neutral quality, found that vitamin E supplementation (300 mg/day from the first day of chemotherapy and continued for three months after the suspension of treatment) significantly protects against cisplatin-induced peripheral neurotoxicity and reduces the incidence and intensity of neuropathic signs and symptoms. Vitamin E supplementation had no significant effect on either clinical response or systemic toxicities.  Larger RCTs are required to validate these findings.

• Grade I means there is Good/Strong evidence supporting the statement;
• Grade II is Fair;
• Grade III is Limited/Weak;
• Grade IV is Expert Opinion Only;
• Grade V is Not Assignable.
• High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
• Moderate (B) means we are moderately confident in the effect estimate;
• Low (C) means our confidence in the effect estimate is limited;
• Very Low (D) means we have very little confidence in the effect estimate.
• Ungraded means a grade is not assignable.

Research does not support or refute the use of supplemental vitamins C and E to improve tolerance or late-effects of radiotherapy treatment in patients with chronic proctitis.  One small, negative quality, before-after time series study reported a reduction in bleeding, diarrhea, and fecal urgency beginning within six weeks of supplementation with 500 mg vitamin C and 400 IU vitamin (taken three times daily) and continued in a subset of patients still taking the supplements a year later.   Large, well-designed studies are needed to address the potential interaction of antioxidants with radiotherapy and treatment outcome.

• Grade I means there is Good/Strong evidence supporting the statement;
• Grade II is Fair;
• Grade III is Limited/Weak;
• Grade IV is Expert Opinion Only;
• Grade V is Not Assignable.
• High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
• Moderate (B) means we are moderately confident in the effect estimate;
• Low (C) means our confidence in the effect estimate is limited;
• Very Low (D) means we have very little confidence in the effect estimate.
• Ungraded means a grade is not assignable.

Results of one RCT of strong design suggests three-year use of high-dose a-tocopherol supplements for older patients with stage I and II head and neck cancer receiving radiation therapy may be associated with an increased occurance of second primary cancers and decreased duration of cancer-free survival.

• Grade I means there is Good/Strong evidence supporting the statement;
• Grade II is Fair;
• Grade III is Limited/Weak;
• Grade IV is Expert Opinion Only;
• Grade V is Not Assignable.
• High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
• Moderate (B) means we are moderately confident in the effect estimate;
• Low (C) means our confidence in the effect estimate is limited;
• Very Low (D) means we have very little confidence in the effect estimate.
• Ungraded means a grade is not assignable.

Research neither supports nor refutes the use of oral vitamin E supplementation for improved tolerance to or outcome of treatment in breast cancer patients undergoing radiation therapy. However, some evidence shows that oral supplementation of vitamin E may be beneficial in treating late-effects of radiation therapy treatment. One positive quality RCT found no effectiveness of oral vitamin E on the treatment of chronic RIF resulting from breast cancer treatment as measured by perometer. A study of neutral quality found an effect, but the fibrosis measurement methodology was not validated. Larger PRCTs with validated measures of radiation therapy effect are needed.

• Grade I means there is Good/Strong evidence supporting the statement;
• Grade II is Fair;
• Grade III is Limited/Weak;
• Grade IV is Expert Opinion Only;
• Grade V is Not Assignable.
• High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
• Moderate (B) means we are moderately confident in the effect estimate;
• Low (C) means our confidence in the effect estimate is limited;
• Very Low (D) means we have very little confidence in the effect estimate.
• Ungraded means a grade is not assignable.

Eight studies regarding the relationship between antioxidants and COPD were reviewed.  Six studies report reduced serum and/or tissue levels of vitamins A, C and/or E in people with COPD.  Three studies regarding supplementation report insignificant effects, however these studies were limited in scope, duration and power.  Further research on the relationship between antioxidants and COPD is needed.   

• Grade I means there is Good/Strong evidence supporting the statement;
• Grade II is Fair;
• Grade III is Limited/Weak;
• Grade IV is Expert Opinion Only;
• Grade V is Not Assignable.
• High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
• Moderate (B) means we are moderately confident in the effect estimate;
• Low (C) means our confidence in the effect estimate is limited;
• Very Low (D) means we have very little confidence in the effect estimate.
• Ungraded means a grade is not assignable.

Research neither supports nor refutes the use of oral vitamin E supplementation to improve tolerance or treatment outcome in head and neck cancer patients receiving radiation therapy; however, limited evidence shows that supplementation with vitamin E may be beneficial for late-effects of treatment. In a neutral quality, before-after time series study, a combination of pentoxifylline (800 mg per day) and vitamin E (1,000 IU/day), boosted for the most serious cases with clodronate (1,600 mg per day, 5 days per week), for 6 to 24 months induced mucosal and bone healing in patients with osteoradionecrosis.  Well-designed studies are needed to determine the benefits of vitamin E supplementation.

• Grade I means there is Good/Strong evidence supporting the statement;
• Grade II is Fair;
• Grade III is Limited/Weak;
• Grade IV is Expert Opinion Only;
• Grade V is Not Assignable.
• High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
• Moderate (B) means we are moderately confident in the effect estimate;
• Low (C) means our confidence in the effect estimate is limited;
• Very Low (D) means we have very little confidence in the effect estimate.
• Ungraded means a grade is not assignable.

Results of two reports, one of neutral and one of negative quality from one RCT found with supplementation with 2,000 mg vitamin C (L-ascorbic acid), 800 mg of vitamin E (dl-a-tocopherol-acetate) and 200 mcg selenium (sodium selenite) had no effect on cisplatin-based chemotherapy toxicity.  Caution must be taken when interpreting these results because in both studies, patient compliance with the milky beverages containing supplements was poor and sample sizes were small.  Further RCTs are required to validate these findings.

• Grade I means there is Good/Strong evidence supporting the statement;
• Grade II is Fair;
• Grade III is Limited/Weak;
• Grade IV is Expert Opinion Only;
• Grade V is Not Assignable.
• High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
• Moderate (B) means we are moderately confident in the effect estimate;
• Low (C) means our confidence in the effect estimate is limited;
• Very Low (D) means we have very little confidence in the effect estimate.
• Ungraded means a grade is not assignable.

In one RCT of neutral quality, antioxidant vitamin E (600 mg/day), vitamin C (1 gm/day, given only on days in which therapy was applied) and N-acetylcysteine (200mg/day, given only on days in which therapy was applied) offered a cardioprotective effect measured via left ventricular ejection fraction for patients undergoing chemotherapy and radiotherapy for neoplastic disease.  Further research is needed to confirm these findings.

• Grade I means there is Good/Strong evidence supporting the statement;
• Grade II is Fair;
• Grade III is Limited/Weak;
• Grade IV is Expert Opinion Only;
• Grade V is Not Assignable.
• High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
• Moderate (B) means we are moderately confident in the effect estimate;
• Low (C) means our confidence in the effect estimate is limited;
• Very Low (D) means we have very little confidence in the effect estimate.
• Ungraded means a grade is not assignable.