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October 8, 1997

Contempo 1997: Family Medicine-Reply

Author Affiliations

University of Pennsylvania School of Medicine Philadelphia

JAMA. 1997;278(14):1151-1152. doi:10.1001/jama.1997.03550140043035

In Reply.  —We agree with Dr Solan that evidence for the efficacy of vitamin E in the prevention of coronary artery disease is less compelling than that for antiplatelet agents and estrogen in women. However, there is considerable evidence of benefit. Large prospective epidemiological cohort studies have shown strong associations between vitamin E use and decreased risk of cardiovascular events. Four populationbased studies involving more than 172 000 men and women show remarkable agreement, with high vitamin E intake being associated with a consistent reduction in risk of cardiovascular morbidity and mortality of between 36% and 58%.1-2Randomized controlled trials, primarily of secondary prevention, have yielded less impressive results. A large randomized controlled trial of large doses of natural (not synthetic) vitamin E in smokers and nonsmokers with proven coronary artery disease showed a risk reduction for nonfatal myocardial infarction and cardiovascular death of 47% in the vitamin E group, but