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. METHODS AND 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.
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. METHODS AND 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.
Authors: Namrata Tomar; Shima Sadri; Allen W Cowley; Chun Yang; Nabeel Quryshi; Venkat R Pannala; Said H Audi; Ranjan K Dash Journal: Free Radic Biol Med Date: 2019-02-13 Impact factor: 7.376
Authors: Christoph Kleinschnitz; Henrike Grund; Kirstin Wingler; Melanie E Armitage; Emma Jones; Manish Mittal; David Barit; Tobias Schwarz; Christian Geis; Peter Kraft; Konstanze Barthel; Michael K Schuhmann; Alexander M Herrmann; Sven G Meuth; Guido Stoll; Sabine Meurer; Anja Schrewe; Lore Becker; Valérie Gailus-Durner; Helmut Fuchs; Thomas Klopstock; Martin Hrabé de Angelis; Karin Jandeleit-Dahm; Ajay M Shah; Norbert Weissmann; Harald H H W Schmidt Journal: PLoS Biol Date: 2010-09-21 Impact factor: 8.029
Authors: V E Kagan; Y Y Tyurina; W Y Sun; I I Vlasova; H Dar; V A Tyurin; A A Amoscato; R Mallampalli; P C A van der Wel; R R He; A A Shvedova; D I Gabrilovich; H Bayir Journal: Free Radic Biol Med Date: 2019-12-25 Impact factor: 7.376
Authors: Sebastian Altenhöfer; Pamela W M Kleikers; Kim A Radermacher; Peter Scheurer; J J Rob Hermans; Paul Schiffers; Heidi Ho; Kirstin Wingler; Harald H H W Schmidt Journal: Cell Mol Life Sci Date: 2012-05-31 Impact factor: 9.261