Heart disease: Vitamin E promotes heart health in women

Any woman concerned about heart health would do herself a favour to pay close attention to vitamin E studies.

Over the past few years we've seen quite a bit of research concerning vitamin E. Some studies have been valuable while others, frankly, have been completely useless. But every now and then we get a well-designed study that provides important insights that researchers will almost certainly put to use for future studies.

A new trial from Brigham and Women's Hospital (BWH) of Harvard Medical School in the US falls into that latter category. And this is one that women - especially older women - should pay particular attention to.

Vitamin E reduces heart disease risk
In a recent issue of the Journal of the American Medical Association, the BWH team states this objective: 'To test whether vitamin E supplementation decreases risks of cardiovascular disease and cancer among healthy women.'

The key word there is 'healthy,' because we've seen vitamin E apparently fail to provide benefits in trails where patients were in poor health while fighting cancer or heart disease. Of course, those trials can't be held up as an indication of what benefits the vitamin may provide for the average person who simply wants to maintain good health. In fact, the BWH study acknowledges that research has already shown that healthy people who have 'high intakes of vitamin E though diet or supplements, have decreased risks of cardiovascular disease and cancer.'

That's a pretty good place to start.

For this trial, researchers enlisted almost 40,000 healthy women from the Women's Health Study. At the outset, all of the women were at least 45 years of age. They were randomly divided into three groups and assigned to take either a high dose (600 IU) of vitamin E every other day, or a placebo and low dose aspirin every other day, or a placebo alone.

After following the medical records of each subject for an average of ten years, researchers found that aspirin intake was not associated with a lower risk of heart attack, stroke or cancer, although there was a lowered risk of lung cancer death in this group - an unexpected link that may be a statistical fluke.

Vitamin E didn't lower risk of heart attack, stroke or cancer, but subjects in the vitamin E group had a 24 percent lower risk of dying from heart disease. At first glance, vitamin E intake would appear to offer a relatively slim benefit, given that this was the longest vitamin E trial ever conducted and participants numbered in the thousands. But when the results are broken down into sub-groups, two impressive results stand out:

* The risk of cardiovascular death was cut in HALF in women over the age of 65 (the age group most affected by heart disease)
* Heart attack risk was reduced by nearly 35 percent in this group

In their conclusions the authors write: 'These data do not support recommending vitamin E supplementation for cardiovascular disease...among healthy women.'

But does that seem logical to you? It doesn't sound right at all to Dr Maret Traber, of the Linus Pauling Institute. Dr. Traber told WebMD Medical News: 'I find that conclusion inexplicable.' Given that vitamin E is well tolerated by nearly everyone, I agree wholeheartedly with Dr. Traber.

Which form is best?
'ANY time you see a placebo-controlled study about vitamin E, this question MUST be answered: What form of the vitamin was used?'

That quote is from the e-alert ' Why not all studies are created equal' (27/4/05), in which I told you about a study that found very large doses of vitamin E to have no effect on cognitive function. But the report of that study made the conclusion moot because there was no mention of what vitamin E form was used.

The BWH team, however, was on the right track: They used natural alpha-tocopherol, also known as d-alpha tocopherol. And while that's an excellent choice, an even better choice would have been a mix of tocopherols: alpha, beta, gamma and delta.

And it's a shame that a dose of selenium wasn't added to the mix. As US HSI Panellist Dr Allan Spreen has mentioned in past e-alerts, selenium enhances the effect of vitamin E. (In addition, this mineral has excellent antioxidant properties and has been shown to help increase insulin efficiency.)

Dosage? Dr. Spreen recommends 400 IU of vitamin E daily (ideally, as d-alpha or mixed tocopherols, of course), as well as 200 mcg of selenium for general antioxidant protection. And while it is possible to get too much selenium, a range of 200-400 mcg daily is considered quite safe.

And Dr. Spreen added this warning: 'Those starting out with vitamin E should start with small amounts and work up. Occasionally the nutrient can be so stimulating to the heart muscle that there can be a transient increase in blood pressure, so your health care practitioner should monitor.'