High-Dosage Vitamin E Supplementation and All-Cause Mortality
Authors: David H. Blatt, William A. Pryor
Journal: Annals of Internal Medicine (2005)

Letters19 July 2005High-Dosage Vitamin E Supplementation and All-Cause MortalityDavid H. Blatt, MD and William A. Pryor, PhDDavid H. Blatt, MDFrom Good Samaritan Regional Medical Center, Corvallis, OR 97330, and Louisiana State University, Baton Rouge, LA 70803. and William A. Pryor, PhDFrom Good Samaritan Regional Medical Center, Corvallis, OR 97330, and Louisiana State University, Baton Rouge, LA 70803.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-143-2-200507190-00018 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:Miller and colleagues (1) concluded that high-dosage vitamin E supplements may increase all-cause mortality. However, we question some of the methods of this meta-analysis. Supplements labeled vitamin E contain either RRR-α-tocopherol (the only naturally occurring stereoisomer of α-tocopherol) or synthetic all-rac-α-tocopherol (a mixture of RRR-α-tocopherol with 7 non-natural stereoisomers). Miller and colleagues combined data from clinical trials that administered either RRR-α-tocopherol or all-rac-α-tocopherol. This is not appropriate, even though there are no known differences in the symptomatic effects of RRR-α-tocopherol and all-rac-α-tocopherols. By definition, products that are different mixtures of stereoisomers are not bioequivalent and are not ...References1. Miller ER, Pastor-Barriuso R, Dalal D, Riemersma RA, Appel LJ, Guallar E. Meta-analysis: high-dosage vitamin E supplementation may increase all-cause mortality. Ann Intern Med. 2005;142:37-46. [PMID: 15537682] LinkGoogle Scholar2. Shargel L, Yu AB. Applied Biopharmaceutics and Pharmacokinetics. Stamford, CT: Appleton-Lange; 1999. Google Scholar3. 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Stephens NG, Parsons A, Schofield PM, Kelly F, Cheeseman K, Mitchinson MJ. Randomised controlled trial of vitamin E in patients with coronary disease: Cambridge Heart Antioxidant Study (CHAOS). Lancet. 1996;347:781-6. [PMID: 8622332] CrossrefMedlineGoogle Scholar13. Mitchinson MJ, Stephens NG, Parsons A, Bligh E, Schofield PM, Brown MJ. Mortality in the CHAOS trial [Letter]. Lancet. 1999;353:381-2. [PMID: 9950454] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Good Samaritan Regional Medical Center, Corvallis, OR 97330, and Louisiana State University, Baton Rouge, LA 70803.Disclosures: None disclosed. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoMeta-Analysis: High-Dosage Vitamin E Supplementation May Increase All-Cause Mortality Edgar R. Miller III , Roberto Pastor-Barriuso , Darshan Dalal , Rudolph A. Riemersma , Lawrence J. 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Miller III Metrics Cited byα-Tocopherol supplementation reduces 5-nitro-γ-tocopherol accumulation by decreasing γ-tocopherol in young adult smokersAntioxidants in Food: Mere Myth or Magic Medicine?Bioactive Nutritional Supplements for Chronic Kidney Disease: Potential Cost BenefitsDecision Analysis Supports the Paradigm That Indiscriminate Supplementation of Vitamin E Does More Harm than GoodVitamin E supplement use and the incidence of cardiovascular disease and all-cause mortality in the Framingham Heart Study: Does the underlying health status play a role?Bayesian model averaging in meta-analysis: vitamin E supplementation and mortalityThe 'vitamin E regeneration system' (VERS) and an algorithm to justify antioxidant supplementation in diabetes – A hypothesisAdverse effects of vitamin E by induction of drug metabolismCellular, molecular and clinical aspects of vitamin E on atherosclerosis preventionVitamin E Regulatory MechanismsThe Roles of α‐Vitamin E and Its Analogues in Prostate CancerDietary Factors That Promote or Retard InflammationComplementary and alternative medicine in urology 19 July 2005Volume 143, Issue 2Page: 150-151KeywordsAntioxidantsAttentionBlood plasmaClinical trial reportingClinical trialsMyocardial infarctionVitamin E ePublished: 19 July 2005 Issue Published: 19 July 2005 Copyright & PermissionsCopyright © 2005 by American College of Physicians. 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