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Beta-Carotene and Vitamin E Are Not Effective for Cardiovascular-Disease Prevention

Investigators have synthesized existing research and put it in perspective.

Because oxidative stress is believed to play an important role in the development of atherosclerosis, antioxidants such as beta-carotene and vitamin E have been touted for prevention of atherosclerosis progression and of adverse cardiovascular events and mortality. Findings from randomized trials have failed to support this hypothesis, and some trial results have even suggested harmful effects of antioxidants.

In a meta-analysis of large, randomized, controlled trials (7 on vitamin E, totaling 81,788 patients; 8 on beta-carotene, totaling 138,113 patients), Cleveland Clinic investigators assessed the effect of these antioxidants on all-cause and cardiovascular mortality. In these trials, vitamin E did not reduce all-cause mortality compared with control treatment, nor did it decrease risk for cerebrovascular accident or cardiovascular death. Compared with control treatment, beta-carotene slightly -- but significantly -- increased risks for all-cause mortality and cardiovascular mortality.

Comment: These meta-analysis data suggest that beta-carotene and vitamin E fail to limit adverse cardiovascular events and that beta-carotene may actually increase risk for cardiovascular death. In view of these findings and recent U.S. Preventive Services Task Force recommendations (Journal Watch Cardiology Aug 22 2003), beta-carotene should not be used to prevent adverse cardiovascular events. Current data are insufficient to indicate any cardiovascular benefit from vitamin E supplementation, so it should not be recommended routinely as preventive therapy.

— JoAnne M. Foody, MD

Published in Journal Watch Cardiology August 22, 2003

Citation(s):

Vivekananthan DP et al. Use of antioxidant vitamins for the prevention of cardiovascular disease: Meta-analysis of randomised trials. Lancet 2003 Jun 14; 361:2017-23.

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