Although a large number of people continue to take vitamin supplements, the long-term health benefits remain unclear. Both vitamins C and E have antioxidant properties that have the potential to slow plaque progression.
The Physicians’ Health Study II was a randomized, double-blind, placebo-controlled factorial trial of vitamin E and vitamin C that ran from 1997 – 2007. 14 641 US male physicians aged over 50 enrolled, 754 of whom (5.1%) had cardiovascular disease at randomization. Participants were given supplements of 400 IU of vitamin E every other day and 500 mg of vitamin C daily. The main outcome measure was a composite end point of major cardiovascular events (nonfatal myocardial infarction, nonfatal stroke, and cardiovascular disease death.
Over a mean follow-up of 8 years, there were 1245 confirmed major cardiovascular events. Vitamin E had no effect on the incidence of major cardiovascular events when compared to placebo (both active and placebo vitamin E groups, 10.9 events per 1000 person-years; hazard ratio [HR], 1.01; P = .86), nor was any difference seen in total myocardial infarction (HR, 0.90 ; P = .22), total stroke (HR, 1.07; P = .45), and cardiovascular mortality (HR, 1.07; P = .43). In addition, there was no significant effect of vitamin C on major cardiovascular events (active and placebo vitamin E groups, 10.8 and 10.9 events per 1000 person-years, respectively; HR, 0.99; P = .91), total myocardial infarction (HR, 1.04; P = .65), total stroke (HR, 0.89; P = .21), or cardiovascular mortality (HR, 1.02; P = .86). Neither vitamin E (HR, 1.07; P = .15) nor vitamin C (HR, 1.07; P = .16) had a significant effect on total mortality. An increased risk of hemorrhagic stroke was noted with vitamin E(HR, 1.74; P = .04).
There currently exists no role for either vitamins C or E in cardiovascular prevention strategy. Although other supplements such as vitamin D and omega-3 fatty acids are currently under investigation, for now the nutritional emphasis in primary prevention should be placed on a maintaining a healthy, balanced diet.
- Sesso HD, Buring JE, Christen WG, et al. Vitamins E and C in the prevention of cardiovascular disease in men: The Physicians’ Health Study II Randomized Controlled Trial. JAMA 2008; 300:2123-2133.