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High-Dosage Vitamin E Supplementation and All-Cause Mortality
- Edgar R. Miller III, MD, PhD;
- Lawrence J. Appel, MD, MPH;
- Eliseo Guallar, MD, DrPH; and
- Roberto Pastor-Barriuso, PhD
- From Johns Hopkins Medical Institutions, Baltimore, MD 21205, and Instituto de Salud Carlos III, 28029 Madrid, Spain.
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IN RESPONSE:
Since the publication of our vitamin E dose–response meta-analysis, we have received hundreds of e-mails, letters, and phone calls as well as more than 40 Letters to the Editor submitted electronically. Annals has asked us to prepare a written response to 11 selected letters.
Blatt and Pryor and Krishnan and associates hypothesize that natural vitamin E supplements have greater benefit than synthetic vitamin E supplements, even though no trial has directly compared them on mortality outcomes. In response, we have performed a subgroup analysis comparing the 4 trials using natural supplements, all high-dosage (400 IU/d), with high-dosage trials using the synthetic form. The relative risks for all-cause mortality in the 4 trials that provided natural vitamin E were 1.00 (95% CI, 0.89 to 1.12) in the Heart Outcomes Prevention Evaluation (HOPE) (1), 1.83 (CI, 0.88 to 3.78) in the VECAT study (2), 1.22 (CI, 0.86 to 1.73) in CHAOS (3, 4 …
