Vitamin E for Heart Health Support
Large randomised trials consistently show no cardiovascular benefit from vitamin E supplementation.
Overview
Verdict
How It Works
Dosing & Protocol
Typical dose
- Recommended dose
- Tested at 400-800 IU/day in large cardiovascular trials; it did not reduce events and increased heart failure
- Expected timeframe
- Not established
Protocol
- form
- Alpha-tocopherol, natural or synthetic, was used in the major trials; the RDA of 15 mg/day is met easily from nuts, seeds and vegetable oils
- duration
- Trials ran 3-10 years
- co factor
- Evidence indicates no benefit and signals of harm. The oxidised-LDL hypothesis made vitamin E the most promising cardiovascular antioxidant of the 1990s, and it does reduce lipid peroxidation markers. The trials were unambiguous: HOPE and HOPE-TOO randomised over 9,500 high-risk patients to 400 IU/day and found no reduction in cardiovascular events, with a significant increase in heart failure and heart failure hospitalisation. GISSI-Prevenzione found no benefit at 300 mg/day, the Physicians Health Study II was null at 400 IU every other day, and Miller meta-analysis found increased all-cause mortality above 400 IU/day.
- titration
- Not applicable - the studied doses failed and caused harm. The tolerable upper intake level is 1,000 mg/day, but harm appeared well below it
- starting dose
- Not recommended. Cardiovascular trials used 400-800 IU/day of alpha-tocopherol
Evidence
What the studies say
Vitamins E and C in the prevention of cardiovascular disease in men: the Physicians' Health Study II randomized controlled trial
Sesso HD, Buring JE, Christen WG +7 more
Neither vitamin E nor vitamin C reduced major cardiovascular events in male physicians.
Safety
Caveats
This is a negative finding with harm attached, not merely an absence of benefit: HOPE found significantly more heart failure and heart failure hospitalisations on 400 IU/day, and the Miller meta-analysis found increased all-cause mortality at doses above 400 IU/day. Vitamin E also inhibits platelet aggregation and antagonises vitamin K, so it raises bleeding risk and has been linked to haemorrhagic stroke in the ATBC trial - it interacts with warfarin, DOACs, aspirin and clopidogrel, all common in cardiovascular patients, and should be stopped at least two weeks before surgery. What reduces cardiovascular events is treating blood pressure, statin therapy where indicated, stopping smoking, physical activity, a Mediterranean-style diet, weight management and glycaemic control - none of which a supplement replaces. Never stop or reduce prescribed cardiac medication for a supplement. In pregnancy, high-dose vitamin E is not recommended: trials in pre-eclampsia prevention found no benefit and possible harm. Chest pain, breathlessness or palpitations need urgent assessment.
Less likely to help if
Medical Disclaimer
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Individual results may vary. The statements on this website have not been evaluated by the Food and Drug Administration. Products and information are not intended to diagnose, treat, cure, or prevent any disease.