title: Vitamin E supplement use and the incidence of cardiovascular disease and all-cause mortality in the Framingham Heart Study: Does the underlying health status play a role?
abstract: BACKGROUND
  Observational studies generally showed beneficial associations between supplemental vitamin E intake and cardiovascular disease (CVD) risk whereas intervention trials reported adverse effects of vitamin E supplements. We hypothesize that these discordant findings result from differing underlying health status of study participants in observational and intervention studies.
  
  
  OBJECTIVE
  Determine if the relation between supplemental vitamin E intake and CVD and all-cause mortality (ACM) depends on pre-existing CVD.
  
  
  METHODS
  Proportional hazards regression to relate supplemental vitamin E intake to the 10-year incidence of CVD and ACM in 4270 Framingham Study participants stratified by baseline CVD status.
  
  
  RESULTS
  Eleven percent of participants used vitamin E supplements at baseline. In participants with pre-existing CVD, there were 28 (44%) and 20 (32%) incident cases of CVD and ACM in the vitamin E supplement users versus 249 (47%) and 202 (38%) in the non-users, respectively (CVD HR, 0.90; 95% CL, 0.60-1.32; ACM HR, 0.74; 95% CL, 0.46-1.17). In participants without pre-existing CVD, there were 51 (13%) and 47 (12%) cases of CVD and ACM in the vitamin E supplement group versus 428 (13%) and 342 (10%) in the non-vitamin E supplement group, respectively (CVD HR, 1.00; 95% CL, 0.75-1.34; ACM HR 1.20; 95% CL, 0.89-1.64).
  
  
  CONCLUSIONS
  CVD status has no apparent influence on the association of supplemental vitamin E intake and risk for CVD and ACM in this large, community-based study. Further research is needed to clarify the basis for the discrepant results between intervention and observational studies of supplemental vitamin E intake.
authors.affiliation: Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, United States. mariondietric@msn.com
authors.forename: M
authors.initials: M
authors.lastname: Dietrich
authors.forename: P F
authors.initials: PF
authors.lastname: Jacques
authors.forename: M J
authors.initials: MJ
authors.lastname: Pencina
authors.forename: K
authors.initials: K
authors.lastname: Lanier
authors.forename: M J
authors.initials: MJ
authors.lastname: Keyes
authors.forename: G
authors.initials: G
authors.lastname: Kaur
authors.forename: P A
authors.initials: PA
authors.lastname: Wolf
authors.forename: R B
authors.initials: RB
authors.lastname: D'Agostino
authors.forename: R S
authors.initials: RS
authors.lastname: Vasan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000401:mortality*; D015331:Cohort Studies; D019587:Dietary Supplements; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012306:Risk; D014810:Vitamin E / Q000378:metabolism*
chemical_list: D014810:Vitamin E