Disorders of Lipid Metabolism

DLM: Vitamin E Supplements (2009)

Vitamin E and Disorders of Lipid Metabolism

• Intervention
  In adults, what is the relationship between supplemental vitamin E and plasma lipid levels?

  • Conclusion

    Supplemental vitamin E given both in natural and synthetic forms does not have a beneficial effect on serum lipids. Study doses varied and were reported to be between 30mg and 1,000mg per day or 400 IU to 3,200 IU per day, alone or in combination with other antioxidants.

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

  • Grade: I
    • 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.
  • Evidence Summary: What is the relationship between supplemental vitamin E and plasma lipid levels?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Aryaeian N, Shahram F, Djalali M, Eshragian MR, Djazayeri A, Sarrafnejad A, Naderi N, Chamari M, Fatehi F, Zarei M. Effect of conjugated linoleic acid, vitamin E and their combination on lipid profiles and blood pressure of Iranian adults with active rheumatoid arthritis. Vasc Health Risk Manag. 2008; 4(6): 1,423-1,432.
      • Ble-Castillo JL, Carmona-Díaz E, Méndez JD, Larios-Medina FJ, Medina-Santillán R, Cleva-Villanueva G, Díaz-Zagoya JC. Effect of alpha-tocopherol on the metabolic control and oxidative stress in female type 2 diabetics. Biomed Pharmacother. 2005; 59: 290-295.
      • Boshtam M, Rafiei M, Golshadi ID, Ani M, Shirani Z, Rostamshirzai M. Long-term effects of oral vitamin E supplement in type II diabetic patients. Int J Vitam Nutr Res. 2005; 75: 341-346.
      • De Caterina R, Cipollone F, Filardo FP, Zimarino M, Bernini W, Lazzerini G, Bucciarelli T, Falco A, Marchesani P, Muraro R, Mezzetti A, Ciabattoni G. Low-density lipoprotein level reduction by the 3-hydroxy-3-methylglutaryl coenzyme-A inhibitor simvastatin is accompanied by a related reduction of F2-isoprostane formation in hypercholesterolemic subjects: No further effect of vitamin E. Circulation. 2002 Nov 12; 106 (20): 2,543-2,549.
      • Leonard SW, Joss JD, Mustacich DJ, Blatt DH, Lee YS, Traber MG. Effects of vitamin E on cholesterol levels of hypercholesterolemic patients receiving statins. Am J Health Syst Pharm. 2007 Nov 1; 64 (21): 2,257-2,266.
      • Magliano D, McNeil J, Branley P, Shiel L, Demos L, Wolfe R, Kotsopoulos D, McGrath B. The Melbourne Atherosclerosis Vitamin E Trial (MAVET): A study of high-dose vitamin E in smokers. Eur J Cardiovasc Prev Rehabil. 2006 Jun; 13(3): 341-347.
      • Manuel-Y-Keenoy B, Vinckx M, Vertommen J, Van Gaal L, De Leeuw I. Impact of vitamin E supplementation on lipoprotein peroxidation and composition in Type 1 diabetic patients treated with Atorvastatin. Atherosclerosis. 2004 Aug; 175 (2): 369-376.
      • McGavin JK, Mann JI, Skeaff CM, Chisholm A. Comparison of a vitamin E-rich diet and supplemental vitamin E on measures of vitamin E status and lipoprotein profile. European Journal of Clinical Nutrition. 2001; 55: 555-561.
      • Mustad VA, Smith CA, Ruey PP, Edens NK, DeMichele SJ. Supplementation with three compositionally different tocotrienol supplements does not improve cardiovascular disease risk factors in men and women with hypercholesterolemia. Am J Clin Nutr. 2002; 76: 1,237-1,243.
      • Rezaian GR, Taheri M, Mozaffari BE, Mosleh AA, Ghalambor MA. The salutary effects of antioxidant vitamins on the plasma lipids of healthy middle aged-to-elderly individuals: a randomized, double-blind, placebo-controlled study. J Med Liban. 2002, Jan-Apr; 50 (1-2): 10-13.
      • Salonen RM, Nyyssönen K, Kaikkonen J, Porkkala-Sarataho E, Voutilainen S, Rissanen TH, Tuomainen TP, Valkonen VP, Ristonmaa U, Lakka HM, Vanharanta M, Salonen JT, Poulsen HE; Antioxidant Supplementation in Atherosclerosis Prevention Study. Six-year effect of combined vitamin C and E supplementation on atherosclerotic progression: The Antioxidant Supplementation in Atherosclerosis Prevention (ASAP) Study. Circulation. 2003 Feb 25; 107 (7): 947-953.
      • Shekelle P, Morton S, Hardy M. Effect of Supplemental Antioxidants Vitamin C, Vitamin E, and Coenzyme Q10 for the Prevention and Treatment of Cardiovascular Disease. Evidence Report/Technology Assessment No. 83 (Prepared by Southern California–RAND Evidence Based Practice Center, under Contract No 290-97-0001). AHRQ Publication No. 03-E043. Rockville, MD: Agency for Healthcare Research and Quality. July 2003. 
      • Singhal S, Gupta R, Goyle A. Comparison of antioxidant efficacy of vitamin E, vitamin C, vitamin A and fruits in coronary heart disease: A controlled trial. J Assoc Physicians India. 2001 Mar; 49: 327-331.
      • Sutken E, Inal M, Ozdemir F. Effects of vitamin E and gemfibrozil on lipid profiles, lipid peroxidation and antioxidant status in the elderly and young hyperlipidemic subjects. Saudi Med J. 2006 Apr; 27(4): 453-459.
  • Search Plan and Results: Antioxidant (Vit E) and CVD Mortality, Morbidity and Lipids 2009
     
  In adults, what is the relationship between supplemental vitamin E and incidence of non-fatal MI and non-fatal stroke?

  • Conclusion

    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
    • 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.
  • Evidence Summary: What is the relationship between supplemental vitamin E and incidence of non-fatal MI and non-fatal stroke?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Buring JE. Aspirin prevents stroke but not MI in women; vitamin E has no effect on CV disease or cancer. Cleve Clin J Med. 2006 Sep; 73 (9): 863-870.
      • Buring JE. Aspirin prevents stroke but not MI in women; vitamin E has no effect on CV disease or cancer. Cleve Clin J Med. 2006 Sep; 73 (9): 863-870.
      • Cook NR, Albert CM, Gaziano M, Zaharris E, MacFadyen J, Danielson E, Buring JE, Manson JE. A randomized factorial trial of vitamins C and E and beta carotene in the secondary prevention of cardiovascular events in women. Arch Intern Med. 2007; 167: 1,610-1,618.
      • Cook NR, Albert CM, Gaziano M, Zaharris E, MacFadyen J, Danielson E, Buring JE, Manson JE. A randomized factorial trial of vitamins C and E and beta carotene in the secondary prevention of cardiovascular events in women. Arch Intern Med. 2007; 167: 1,610-1,618.
      • El-Sohemy. Dietary and adipose tissue gamma-tocopherol and risk of myocardial infarction. Epidemiology. 2002;13:216-223.
      • El-Sohemy. Dietary and adipose tissue gamma-tocopherol and risk of myocardial infarction. Epidemiology. 2002;13:216-223.
      • Isaksson B, Andersson C, Asplund K, von Bahr C, Borgström B, Boström H, Dahlgren H, Hallerby N, Marké L Å, Ribohn M, Werkö L, Engström-Laurent A, Lingnert H, Åkerlund B.  Preventing disease with antioxidants - systematic review (Vol.1 & 2). Summary and Conclusions. Swedish Council on Technology Assessment in Health Care (SBU), 1997. Full Report Not Available in English.Database searched: Centre for Reviews and Dissemination
        ISBN: 91-87890-40-2
        Report number: 135/1,2:1 och 2:2.
      • Isaksson B, Andersson C, Asplund K, von Bahr C, Borgström B, Boström H, Dahlgren H, Hallerby N, Marké L Å, Ribohn M, Werkö L, Engström-Laurent A, Lingnert H, Åkerlund B.  Preventing disease with antioxidants - systematic review (Vol.1 & 2). Summary and Conclusions. Swedish Council on Technology Assessment in Health Care (SBU), 1997. Full Report Not Available in English.Database searched: Centre for Reviews and Dissemination
        ISBN: 91-87890-40-2
        Report number: 135/1,2:1 och 2:2.
      • Lee IM, Cook NR, Gaziano JM, Gordon D, Ridker PM, Manson JE, Hennekens CH, Buring JE. Vitamin E in the primary prevention of cardiovascular disease and cancer: the Women's Health Study: a randomized controlled trial. JAMA. 2005 Jul 6; 294 (1): 56-65.
      • Lee IM, Cook NR, Gaziano JM, Gordon D, Ridker PM, Manson JE, Hennekens CH, Buring JE. Vitamin E in the primary prevention of cardiovascular disease and cancer: the Women's Health Study: a randomized controlled trial. JAMA. 2005 Jul 6; 294 (1): 56-65.
      • Lonn E, Bosch J, Yusuf S, Sheridan P, Pogue J, Arnold JM, Ross C, Arnold A, Sleight P, Probstfield J, Dagenais GR; HOPE and HOPE-TOO Trial Investigators. Effects of long-term vitamin E supplementation on cardiovascular events and cancer: a randomized controlled trial. JAMA. 2005 Mar 16; 293 (11): 1,338-1,347.
      • Lonn E, Bosch J, Yusuf S, Sheridan P, Pogue J, Arnold JM, Ross C, Arnold A, Sleight P, Probstfield J, Dagenais GR; HOPE and HOPE-TOO Trial Investigators. Effects of long-term vitamin E supplementation on cardiovascular events and cancer: a randomized controlled trial. JAMA. 2005 Mar 16; 293 (11): 1,338-1,347.
      • Marchioli R, Levantesi G, Macchia A, Marfisi RM, Nicolosi GL, Tavazzi L, Tognoni G, Valagussa F; GISSI-Prevenzione Investigators. Vitamin E increases the risk of developing heart failure after myocardial infarction: Results from the GISSI-Prevenzione trial. J Cardiovasc Med. 2006 May; 7(5): 347-350.
      • Marchioli R, Levantesi G, Macchia A, Marfisi RM, Nicolosi GL, Tavazzi L, Tognoni G, Valagussa F; GISSI-Prevenzione Investigators. Vitamin E increases the risk of developing heart failure after myocardial infarction: Results from the GISSI-Prevenzione trial. J Cardiovasc Med. 2006 May; 7(5): 347-350.
      • Sesso HD, Buring JE, Christen WG, Kurth T, Belanger C, MacFadyen J, Bubes V, Manson JE, Glynn RJ, Gaziano JM. Vitamins E and C in the prevention of cardiovascular disease in men: The Physicians' Health Study II randomized controlled trial. JAMA. 2008 Nov 12; 300 (18): 2,123-2,133. Epub 2008 Nov 9. 
      • Sesso HD, Buring JE, Christen WG, Kurth T, Belanger C, MacFadyen J, Bubes V, Manson JE, Glynn RJ, Gaziano JM. Vitamins E and C in the prevention of cardiovascular disease in men: The Physicians' Health Study II randomized controlled trial. JAMA. 2008 Nov 12; 300 (18): 2,123-2,133. Epub 2008 Nov 9. 
      • Shekelle P, Morton S, Hardy M. Effect of Supplemental Antioxidants Vitamin C, Vitamin E, and Coenzyme Q10 for the Prevention and Treatment of Cardiovascular Disease. Evidence Report/Technology Assessment No. 83 (Prepared by Southern California–RAND Evidence Based Practice Center, under Contract No 290-97-0001). AHRQ Publication No. 03-E043. Rockville, MD: Agency for Healthcare Research and Quality. July 2003. 
      • Shekelle P, Morton S, Hardy M. Effect of Supplemental Antioxidants Vitamin C, Vitamin E, and Coenzyme Q10 for the Prevention and Treatment of Cardiovascular Disease. Evidence Report/Technology Assessment No. 83 (Prepared by Southern California–RAND Evidence Based Practice Center, under Contract No 290-97-0001). AHRQ Publication No. 03-E043. Rockville, MD: Agency for Healthcare Research and Quality. July 2003. 
      • Tornwall ME, Virtamo J, Korhonen PA, et al. Effect of alpha-tocopherol and beta-carotene supplementation on coronary heart disease during the 6-year post-trial follow-up in the ATBC study. European Heart Journal. 2004; 25: 1,171-1,178.
      • Tornwall ME, Virtamo J, Korhonen PA, et al. Effect of alpha-tocopherol and beta-carotene supplementation on coronary heart disease during the 6-year post-trial follow-up in the ATBC study. European Heart Journal. 2004; 25: 1,171-1,178.
      • Vivekananthan DP, Penn MS, Sapp SK, Hsu A, Topol EJ. Use of antioxidant vitamins for the prevention of cardiovascular disease: meta-analysis of randomized trials. Lancet. 2003;361:2017-2023.
      • Vivekananthan DP, Penn MS, Sapp SK, Hsu A, Topol EJ. Use of antioxidant vitamins for the prevention of cardiovascular disease: meta-analysis of randomized trials. Lancet. 2003;361:2017-2023.
    • Related Topics
  • Search Plan and Results: Antioxidant (Vit E) and CVD Mortality, Morbidity and Lipids 2009
     
  In adults, what is the relationship between supplemental vitamin E and cardiovascular disease mortality (from MI and stroke)?

  • Conclusion

    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
    • 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.
  • Evidence Summary: What is the relationship between supplemental vitamin E and cardiovascular disease mortality (from MI and stroke)?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Buring JE. Aspirin prevents stroke but not MI in women; vitamin E has no effect on CV disease or cancer. Cleve Clin J Med. 2006 Sep; 73 (9): 863-870.
      • Cook NR, Albert CM, Gaziano M, Zaharris E, MacFadyen J, Danielson E, Buring JE, Manson JE. A randomized factorial trial of vitamins C and E and beta carotene in the secondary prevention of cardiovascular events in women. Arch Intern Med. 2007; 167: 1,610-1,618.
      • Isaksson B, Andersson C, Asplund K, von Bahr C, Borgström B, Boström H, Dahlgren H, Hallerby N, Marké L Å, Ribohn M, Werkö L, Engström-Laurent A, Lingnert H, Åkerlund B.  Preventing disease with antioxidants - systematic review (Vol.1 & 2). Summary and Conclusions. Swedish Council on Technology Assessment in Health Care (SBU), 1997. Full Report Not Available in English.Database searched: Centre for Reviews and Dissemination
        ISBN: 91-87890-40-2
        Report number: 135/1,2:1 och 2:2.
      • Lee IM, Cook NR, Gaziano JM, Gordon D, Ridker PM, Manson JE, Hennekens CH, Buring JE. Vitamin E in the primary prevention of cardiovascular disease and cancer: the Women's Health Study: a randomized controlled trial. JAMA. 2005 Jul 6; 294 (1): 56-65.
      • Lonn E, Bosch J, Yusuf S, Sheridan P, Pogue J, Arnold JM, Ross C, Arnold A, Sleight P, Probstfield J, Dagenais GR; HOPE and HOPE-TOO Trial Investigators. Effects of long-term vitamin E supplementation on cardiovascular events and cancer: a randomized controlled trial. JAMA. 2005 Mar 16; 293 (11): 1,338-1,347.
      • Marchioli R, Levantesi G, Macchia A, Marfisi RM, Nicolosi GL, Tavazzi L, Tognoni G, Valagussa F; GISSI-Prevenzione Investigators. Vitamin E increases the risk of developing heart failure after myocardial infarction: Results from the GISSI-Prevenzione trial. J Cardiovasc Med. 2006 May; 7(5): 347-350.
      • Sesso HD, Buring JE, Christen WG, Kurth T, Belanger C, MacFadyen J, Bubes V, Manson JE, Glynn RJ, Gaziano JM. Vitamins E and C in the prevention of cardiovascular disease in men: The Physicians' Health Study II randomized controlled trial. JAMA. 2008 Nov 12; 300 (18): 2,123-2,133. Epub 2008 Nov 9. 
      • Shekelle P, Morton S, Hardy M. Effect of Supplemental Antioxidants Vitamin C, Vitamin E, and Coenzyme Q10 for the Prevention and Treatment of Cardiovascular Disease. Evidence Report/Technology Assessment No. 83 (Prepared by Southern California–RAND Evidence Based Practice Center, under Contract No 290-97-0001). AHRQ Publication No. 03-E043. Rockville, MD: Agency for Healthcare Research and Quality. July 2003. 
      • Tornwall ME, Virtamo J, Korhonen PA, et al. Effect of alpha-tocopherol and beta-carotene supplementation on coronary heart disease during the 6-year post-trial follow-up in the ATBC study. European Heart Journal. 2004; 25: 1,171-1,178.
      • Vivekananthan DP, Penn MS, Sapp SK, Hsu A, Topol EJ. Use of antioxidant vitamins for the prevention of cardiovascular disease: meta-analysis of randomized trials. Lancet. 2003;361:2017-2023.
    • Related Topics
  • Search Plan and Results: Antioxidant (Vit E) and CVD Mortality, Morbidity and Lipids 2009