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New Women’s Health Study Data on Vitamin E and Aspirin

These two therapies did not show a benefit for primary prevention of cancer, and vitamin E did not prevent cardiovascular disease.

New data from the Women’s Health Study (WHS) help to clarify the value of aspirin for preventing cancer and of vitamin E for preventing cancer and cardiovascular disease (CVD). This randomized, placebo-controlled, 2x2-design trial of low-dose aspirin (100 mg every other day) and vitamin E (600 IU every other day) enrolled 39,876 U.S. women who had no history of cancer, CVD, or other major chronic illness and were at least 45 years old (28% premenopausal). Mean follow-up was 10 years.

Compared with placebo, aspirin showed no benefit for preventing cancer overall or for preventing breast or colorectal cancer specifically. However, a nonsignificant trend toward benefit was found for preventing lung cancer. Aspirin also did not prevent cancer mortality, except for lung-cancer mortality. Vitamin E use did not influence the effect of aspirin on cancer endpoints.

Vitamin E did not show a benefit over placebo for preventing cancer, major CVD events overall, or all-cause mortality. Vitamin E did show a significant benefit for preventing CVD-related death, but not for preventing MI or stroke. Aspirin use did not influence the effect of vitamin E on cancer or all-cause mortality.

Comment: An editorialist mentions previous observational data that show moderate- to high-dose aspirin might reduce risk for colorectal cancer (and possibly other cancers). However, the WHS data suggest that low-dose aspirin has no such value in women. Determining whether higher aspirin doses can prevent cancer requires further trials. Regarding vitamin E, ongoing trials in other cohorts might find a role in preventing cancer, but the WHS data suggest that vitamin E provides no protection against cancer in women. In addition, vitamin E offered no overall protection against CVD. The isolated benefit for preventing CVD-related death contradicts previous evidence of potential harm from vitamin E (Ann Intern Med 2005; 142:37). Vitamin E should not be used to prevent CVD events. Efforts to prevent cancer and CVD should focus on therapies and lifestyle changes that we know reduce risk.

— JoAnne M. Foody, MD

Published in Journal Watch Cardiology August 12, 2005

Citation(s):

Cook NR et al. Low-dose aspirin in the primary prevention of cancer. The Women's Health Study: A randomized controlled trial. JAMA 2005 Jul 6; 294:47-55.

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Lee I-M et al. Vitamin E in the primary prevention of cardiovascular disease and cancer. The Women's Health Study: A randomized controlled trial. JAMA 2005 Jul 6; 294:56-65.

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Jacobs EJ and Thun MJ. Low-dose aspirin and vitamin E: Challenges and opportunities in cancer prevention. JAMA 2005 Jul 6; 294:105-6.

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Redberg RF. Vitamin E and cardiovascular health: Does sex matter? JAMA 2005 Jul 6; 294:107-9.

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