title: Higher baseline serum concentrations of vitamin E are associated with lower total and cause-specific mortality in the Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study.
abstract: BACKGROUND
  A meta-analysis of 19 trials suggested a small increase in the risk of all-cause mortality with high-dose vitamin E supplementation. Little is known, however, about the relation between mortality and circulating concentrations of vitamin E resulting from dietary intake, low-dose supplementation, or both.
  
  
  OBJECTIVE
  We examined whether baseline serum alpha-tocopherol concentrations are associated with total and cause-specific mortality.
  
  
  METHODS
  A prospective cohort study of 29 092 Finnish male smokers aged 50-69 y who participated in the Alpha-Tocopherol, Beta-Carotene Cancer Prevention (ATBC) Study was carried out. Fasting serum alpha-tocopherol was measured at baseline by using HPLC. Only 10% of participants reported vitamin E supplement use at baseline, and thus serum concentrations of vitamin E mainly reflected dietary intake and other host factors. Risks of total and cause-specific mortality were estimated by using proportional hazards models.
  
  
  RESULTS
  During up to 19 y of follow-up, 13 380 deaths (including 4518 and 5776 due to cancer and cardiovascular disease, respectively) were identified. Men in the higher quintiles of serum alpha-tocopherol had significantly lower risks of total and cause-specific mortality than did those in the lowest quintile [relative risk (RR) = 0.82 (95% CI: 0.78, 0.86) for total mortality and 0.79 (0.72, 0.86), 0.81 (0.75, 0.88), and 0.70 (0.63, 0.79) for deaths due to cancer, cardiovascular disease, and other causes, respectively; P for trend for all < 0.0001]. Cubic regression spline analysis of continuous serum alpha-tocopherol values indicated greater risk reductions with increasing concentrations up to approximately 13-14 mg/L, after which no further benefit was noted.
  
  
  CONCLUSIONS
  Higher circulating concentrations of alpha-tocopherol within the normal range are associated with significantly lower total and cause-specific mortality in older male smokers.
authors.affiliation: Nutritional Epidemiology Branch and the Genetic Epidemiology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA. wrighmar@mail.nih.gov
authors.forename: Margaret E
authors.initials: ME
authors.lastname: Wright
authors.forename: Karla A
authors.initials: KA
authors.lastname: Lawson
authors.forename: Stephanie J
authors.initials: SJ
authors.lastname: Weinstein
authors.forename: Pirjo
authors.initials: P
authors.lastname: Pietinen
authors.forename: Philip R
authors.initials: PR
authors.lastname: Taylor
authors.forename: Jarmo
authors.initials: J
authors.lastname: Virtamo
authors.forename: Demetrius
authors.initials: D
authors.lastname: Albanes
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000097:blood / Q000453:epidemiology / Q000401:mortality*; D002423:Cause of Death; D002851:Chromatography, High Pressure Liquid / Q000379:methods; D015331:Cohort Studies; D016001:Confidence Intervals; D004032:Diet; D019587:Dietary Supplements; D004305:Dose-Response Relationship, Drug; D005215:Fasting; D005387:Finland; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D015201:Meta-Analysis as Topic; D008875:Middle Aged; D009026:Mortality; D009369:Neoplasms / Q000097:blood / Q000453:epidemiology / Q000401:mortality*; D016017:Odds Ratio; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012907:Smoking; D014810:Vitamin E / Q000009:adverse effects / Q000097:blood*; D024502:alpha-Tocopherol / Q000097:blood
chemical_list: D014810:Vitamin E; D024502:alpha-Tocopherol