Decision analysis supports the paradigm that indiscriminate supplementation of vitamin E does more harm than good.
OBJECTIVE
For many years, the prevailing concept was that LDL oxidation plays a central role in atherogenesis. As a consequence, supplementation of antioxidants, particularly vitamin E, became very popular. Unfortunately, however, the major randomized clinical trials have yielded disappointing results on the effects of vitamin E on both mortality and morbidity. Moreover, recent meta-analyses have concluded that vitamin E supplementation increases mortality. This conclusion has raised much criticism, most of it relating to three issues: (1) the choice of clinical trials to be included in the meta-analyses; (2) the end point of these meta-analyses (only mortality); and (3) the heterogeneity of the analyzed clinical trials with respect to both population and treatment. Our goal was to bring this controversy to an end by using a Markov-model approach, which is free of most of the limitations involved in using meta-analyses.


RESULTS
We used a Markov model to compare the vitamin E supplemented virtual cohorts with nonsupplemented cohorts derived from published randomized clinical trials that were included in at least one of the major meta-analyses. The difference between the virtual supplemented and nonsupplemented cohorts is given in terms of a composite end point denoted quality-adjusted life year (QALY). The vitamin E supplemented virtual cohort had 0.30 QALY (95%CI 0.21 to 0.39) less than the nontreated virtual cohort.


CONCLUSIONS
Our study demonstrates that in terms of QALY, indiscriminate supplementation of high doses of vitamin E is not beneficial in preventing CVD. Selective supplementation of vitamin E to individuals under oxidative stress requires further investigation.
Dotan
Yedidya
Y
Department of Physiology and Pharmacology, Tel Aviv University, Sackler Faculty of Medicine, Israel.
Pinchuk
Ilya
I
Lichtenberg
Dov
D
Leshno
Moshe
M
D000328:Adult; D000975:Antioxidants / Q000009:adverse effects*; D050197:Atherosclerosis / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D002318:Cardiovascular Diseases / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D003198:Computer Simulation; D003661:Decision Support Techniques; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D008297:Male; D008390:Markov Chains; D015201:Meta-Analysis as Topic; D008875:Middle Aged; D019057:Quality-Adjusted Life Years; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D016896:Treatment Outcome; D014810:Vitamin E / Q000009:adverse effects*
D000975:Antioxidants; D014810:Vitamin E