Letters Section Editor: Robert M. Golub,
MD, Senior Editor.
In Reply: Dr Richey raises the potential confounding
effect of glitazone use on heart failure. We did not collect detailed data
on glitazone use in HOPE and HOPE-TOO because the trial was designed in the
early 1990s, before recognition of the potential impact of glitazones on heart
failure. However, HOPE is a randomized double-blind trial, so that it is unlikely
that glitazones would be preferentially used in the vitamin E group. Furthermore,
we did collect data on overall use of oral hypoglycemic agents and this was
similar in the vitamin E and placebo groups (22.2% vs 21.4% at baseline, 23.8%
vs 21.3% at 4 years, and 24.5% vs 24.6% at study end, respectively). We have
previously reported that vitamin E has a neutral effect on glycemic control
and on the development of new-onset diabetes mellitus,1 which
further makes a differential use of glitazones unlikely.
Lonn E. Vitamin E Supplementation, Cardiovascular Events, and Cancer—Reply. JAMA. 2005;294(4):425-426. doi:10.1001/jama.294.4.426-a