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Effect of vitamin E and beta carotene on the incidence of primary nonfatal myocardial infarction and fatal coronary heart disease.

Abstract

BACKGROUND

Oxidized low-density lipoprotein is involved in the pathogenesis of atherosclerosis. In epidemiological studies antioxidants have been inversely related with coronary heart disease. Findings from controlled trials are inconclusive.

METHODS

We studied the primary preventive effect of vitamin E (alpha tocopherol) and beta carotene supplementation on major coronary events in the Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study, a controlled trial undertaken primarily to examine the effects of these agents on cancer. A total of 27 271 Finnish male smokers aged 50 to 69 years with no history of myocardial infarction were randomly assigned to receive vitamin E (50 mg), beta carotene (20 mg), both agents, or placebo daily for 5 to 8 years (median, 6.1 years). The end point was the first major coronary event, either nonfatal myocardial infarction (surviving at least 28 days; n = 1204) or fatal coronary heart disease (n = 907).

RESULTS

The incidence of primary major coronary events decreased 4% (95% confidence interval, -12% to 4%) among recipients of vitamin E and increased 1% (95% confidence interval, -7% to 10%) among recipients of beta carotene compared with the respective nonrecipients. Neither agent affected the incidence of nonfatal myocardial infarction. Supplementation with vitamin E decreased the incidence of fatal coronary heart disease by 8% (95% confidence interval, -19% to 5%), but beta carotene had no effect on this end point.

CONCLUSIONS

Supplementation with a small dose of vitamin E has only marginal effect on the incidence of fatal coronary heart disease in male smokers with no history of myocardial infarction, but no influence on nonfatal myocardial infarction. Supplementation with beta carotene has no primary preventive effect on major coronary events.

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  • Authors+Show Affiliations

    ,

    National Public Health Institute, Helsinki, Finland. jarmo.virtamo@ktl.fi

    , , , , ,

    Source

    Archives of internal medicine 158:6 1998 Mar 23 pg 668-75

    MeSH

    Aged
    Cardiovascular Agents
    Coronary Disease
    Dietary Supplements
    Female
    Humans
    Incidence
    Male
    Middle Aged
    Myocardial Infarction
    Risk
    Treatment Outcome
    Vitamin E
    beta Carotene

    Pub Type(s)

    Clinical Trial
    Journal Article
    Randomized Controlled Trial
    Research Support, U.S. Gov't, P.H.S.

    Language

    eng

    PubMed ID

    9521232

    Citation

    Virtamo, J, et al. "Effect of Vitamin E and Beta Carotene On the Incidence of Primary Nonfatal Myocardial Infarction and Fatal Coronary Heart Disease." Archives of Internal Medicine, vol. 158, no. 6, 1998, pp. 668-75.
    Virtamo J, Rapola JM, Ripatti S, et al. Effect of vitamin E and beta carotene on the incidence of primary nonfatal myocardial infarction and fatal coronary heart disease. Arch Intern Med. 1998;158(6):668-75.
    Virtamo, J., Rapola, J. M., Ripatti, S., Heinonen, O. P., Taylor, P. R., Albanes, D., & Huttunen, J. K. (1998). Effect of vitamin E and beta carotene on the incidence of primary nonfatal myocardial infarction and fatal coronary heart disease. Archives of Internal Medicine, 158(6), pp. 668-75.
    Virtamo J, et al. Effect of Vitamin E and Beta Carotene On the Incidence of Primary Nonfatal Myocardial Infarction and Fatal Coronary Heart Disease. Arch Intern Med. 1998 Mar 23;158(6):668-75. PubMed PMID: 9521232.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Effect of vitamin E and beta carotene on the incidence of primary nonfatal myocardial infarction and fatal coronary heart disease. AU - Virtamo,J, AU - Rapola,J M, AU - Ripatti,S, AU - Heinonen,O P, AU - Taylor,P R, AU - Albanes,D, AU - Huttunen,J K, PY - 1998/4/1/pubmed PY - 1998/4/1/medline PY - 1998/4/1/entrez SP - 668 EP - 75 JF - Archives of internal medicine JO - Arch. Intern. Med. VL - 158 IS - 6 N2 - BACKGROUND: Oxidized low-density lipoprotein is involved in the pathogenesis of atherosclerosis. In epidemiological studies antioxidants have been inversely related with coronary heart disease. Findings from controlled trials are inconclusive. METHODS: We studied the primary preventive effect of vitamin E (alpha tocopherol) and beta carotene supplementation on major coronary events in the Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study, a controlled trial undertaken primarily to examine the effects of these agents on cancer. A total of 27 271 Finnish male smokers aged 50 to 69 years with no history of myocardial infarction were randomly assigned to receive vitamin E (50 mg), beta carotene (20 mg), both agents, or placebo daily for 5 to 8 years (median, 6.1 years). The end point was the first major coronary event, either nonfatal myocardial infarction (surviving at least 28 days; n = 1204) or fatal coronary heart disease (n = 907). RESULTS: The incidence of primary major coronary events decreased 4% (95% confidence interval, -12% to 4%) among recipients of vitamin E and increased 1% (95% confidence interval, -7% to 10%) among recipients of beta carotene compared with the respective nonrecipients. Neither agent affected the incidence of nonfatal myocardial infarction. Supplementation with vitamin E decreased the incidence of fatal coronary heart disease by 8% (95% confidence interval, -19% to 5%), but beta carotene had no effect on this end point. CONCLUSIONS: Supplementation with a small dose of vitamin E has only marginal effect on the incidence of fatal coronary heart disease in male smokers with no history of myocardial infarction, but no influence on nonfatal myocardial infarction. Supplementation with beta carotene has no primary preventive effect on major coronary events. SN - 0003-9926 UR - https://www.unboundmedicine.com/medline/citation/9521232/Effect_of_vitamin_E_and_beta_carotene_on_the_incidence_of_primary_nonfatal_myocardial_infarction_and_fatal_coronary_heart_disease_ L2 - https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/vol/158/pg/668 DB - PRIME DP - Unbound Medicine ER -