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Vitamin E Supplementation Reduces Risk of Heart Disease, Cancer and All-Cause Mortality in Elderly Subjects
James Meschino DC, MS, ROHP
There is substantial evidence that Vitamin E supplementation reduces risk of heart disease, certain cancers, and all-cause mortality. The majority of these studies have involved younger and middle-aged subjects. Very few studies have investigated the protective effect of supplementation in elderly individuals. Reporting in the American Journal of Clinical Nutrition in August of 1996 Drs. Losonczy, Harris and Havlik examined Vitamin E and Vitamin C supplementation use in relation to mortality risk in 11,178 persons aged 62-105 years old who participated in the Established Populations for Epidemiologic Studies of the Elderly in 1984-1993.
Use of Vitamin E supplementation reduced the risk of all-cause mortality by 34 percent and risk of heart disease mortality by 47 to 63 percent and cancer risk by 59 percent versus non users of any supplements. Simultaneous use of both Vitamin C and Vitamin E lowered the risk of all-cause mortality to 42 percent. These findings remained after factoring in alcohol use, smoking history, aspirin use, and medical conditions.
An important finding was that the use of a regular multiple vitamin and mineral supplement was not associated with a reduction in risk of all-cause mortality. This is consistent with results of a prospective study of a nationally representative sample of 10,758 men and women aged 25-74 years old, in which no protection against mortality was found for vitamin/mineral supplement users compared with nonusers. As these authors indicate, although multiple vitamin/mineral supplements may contain some Vitamin E, the concentrations may not be high enough to be protective for all-cause mortality and coronary heart disease mortality. In the Nurses’ Health Study, a dosage of 100 I.U. or higher per day was required to reduce risk of heart attack and related problems by approximately 40 percent. Lower levels of Vitamin E intake were not associated with a protective effect. Most regular multiple vitamins contain 12-30 I.U. of Vitamin E, which appears to an ineffective dosage according to this evidence.
The plausible biological mechanisms related to Vitamin E’s protective effect include a number of important features of Vitamin E activity. The lower risk for heart disease likely stems from Vitamin E’s ability to protect LDL-cholesterol from free-radical oxidation, reduction in platelet stickiness and in arterial stiffness, according to Losonczy et a. LDL-cholesterol that is not damaged by oxygen free radicals in the bloodstream is less inclined to adhere to the artery wall-causing blockage. Platelets that are less sticky tend not to clot abnormally in the bloodstream. This also reduces risk of blockage to blood flow. Less arterial stiffness reduces risk of high blood pressure, stroke and atherosclerosis (narrowed arteries).
In regards to cancer protection, Vitamin E and Vitamin C reduce free radical damage to genetic material (DNA), helping to prevent the development of mutations and cancer cells.
Both vitamins also have been shown to stimulate immune system function in human supplementation studies. As well, Vitamin E influences the formation of prostaglandins. Prostaglandins are mini hormones that affect cancer risk, heart disease risk, and inflammatory response and immune system behavior. Vitamin E supplementation has been shown to have a favorable influence on the type of prostaglandins made by the body.
In previous human studies blood levels and intake levels of Vitamin E have been correlated with reduced risk of heart disease and cancer. Hodis et al reported that Vitamin E supplementation was associated with reduced coronary artery lesion progression in a clinical trial of 156 middle-aged men. Meyers et al, Manson et al, Donnan et al, Maxwell et al, and Gey et al have demonstrated that higher blood levels and intake levels of Vitamin E were associated with reduced risk of atherosclerosis, coronary heart disease, and stroke.
Higher serum concentrations of Vitamin E were significantly related to reduction in risk of angina in a case-control study of men aged 35-54 years old, as reported by Riemersma et al. In a large cross-cultural study of men Gey et al demonstrated that higher Vitamin E blood levels were associated with reduced risk of ischaemic heart disease. Blood levels of 25-30 micromoles per liter were highly protective in this study. Other studies by Knekt et al, Bolton-Smith et al, Rimm et al, and Stampfer et al have all reported that higher levels of Vitamin E intake (primarily supplements) were associated with a significant reduction in risk of heart disease.
Antioxidants, including Vitamin E, have also been associated with a reduced risk of certain cancers. This evidence is provided by Hennekins et al, Kirkpartrick et al, Taylor et al, Li et al and Gridley et al. The study by Losonczy, Harris and Havlik suggest that even elderly individuals are likely to benefit from the inclusion of antioxidant supplementation, particularly Vitamin E and Vitamin C. Too often this segment of the population is not included in studies involved with prevention and health promotion. Clearly, studies such as this one demonstrate the fact that elderly people are as likely to benefit from supplementation as are younger persons. Furthermore, Meydani, Prasad and others have shown that antioxidant supplementation can greatly improve immune systems function in elderly people, who typically show signs of age-related decline in this capacity. Hopefully more prevention and health promotion studies will target this sub population, who are at greatest risk for these and other degenerative diseases. In the meantime sufficient evidence exists to suggest that seniors and elderly persons would benefit from an antioxidant-enriched multiple vitamin and mineral unless contra-indicated by the concurrent intake of certain medications or medical conditions.
- Losonczy KG, Harris TB, Havlik RJ. Vitamin E and Vitamin C supplement use and risk of all-cause and coronary heart disease mortality in older persons: The Established Populations for Epidemiologic Studies of the Elderly. The American Journal Clinical Nutrition, 1996; 64; 2:190-196.
- Wang Y, Huang DS, Eskelson CD, Watson RR. Long-term dietary vitamin E retards development of retrovirus-induced disregulation in cytokine production. Clin Immunol Immunopathol 1994; 72:70-5.
- Omach EH, Kidao S, Sanders BG, Kline K. Effects of RRR-a-tocopherol succinate on IL-1 and PGE2 production macrophages. Nutr Cancer 1993:20:205-14.
- Bendich A. Physiological role of antioxidants in the immune system. J Dairy Sci 1993;76:2789-94.
- Meydani SN, Hayek M, Coleman L. Influence of vitamins E and B6 on immune response. Ann N Y Acad Sci 1992;669:125-39 (discussion 139-40).
- Roebothan BV, Chandra RK. Relationship between nutritional status and immune function of elderly people. Age Ageing 1994;23:49-53.
- Kelleher J. Vitamin E and the immune response. Proc Nutr Soc 1991;50:245-9.
- Penn ND, Purkins L, Kelleher J, et al. The effect of dietary supplementation with vitamins A, C and E on cell-mediated immune function in elderly long-stay patients: a randomized controlled trial. Age Ageing 1991;20:169-74.
- Hodis HN, Mack WJ, LaBree L, et al. Serial coronary angiographic evidence that antioxidant vitamin intake reduces progression of coronary artery atherosclerosis. JAMA 1995;273:1849-54.
- Meyers DG, Maloley PA. The antioxidant vitamins: impact on atherosclerosis. Pharmacotherapy 1993;13:574-82.
- Manson JE, Gaziano JM, Jonas MA, Hennekens CH. Antioxidants and cardiovascular disease: a review. J AM Coll Nutr 1993; 12:426-32.
- Donnan PT, Thomson M, Fowkes FGR, Prescott RJ, Housely E. Diet as a risk factor for peripheral arterial disease in the general population: The Edinburgh Artery Study. Am J Clin Nutr 1993;57:917-21.
- Maxwell Sr. Can antioxidants prevent ischaemic heart disease? J Clin Pharm Ther 1993;18:85-95.
- Gey KF, Brubacher GB, Stahelin HB. Plasma levels of antioxidant vitamins in relation to ischemic heart disease and cancer. Am J Clin Nutr 1987;45:1368-77.
- Riemersma RA, Wood DA, Macintyre CC, et al. Risk of angina pectoris and plasma concentrations of vitamins A, C, and E and carotene. Lancet 1991;337:1-5.
- Gey KF, Puska P, Jordon P, Moser UK. Inverse correlation between plasma vitamin E and mortality from ischemic heart disease in cross-cultural epidemiology. Am J Clin Nutr 1991;53:326S-34S.
- Hennekens CH. Antioxidant vitamins and cancer. Am J Med 1994;97(suppl):2S-4S(discussion 22S-8S).
- Kirkpatrick CS, White E, Lee JA. Case-control study of malignant melanoma in Washington State. II. Diet alcohol and obesity. Am J Epidemiol 1994;139:869-80.
- Taylor Pr, Li B, Dawsey SM, et al. Prevention of esophageal cancer: the nutrition intervention trials in Linxian, China. Cancer Res 1994;54(suppl 7):2029S-31S.
- Li JY, Li B, Blot WJ, Taylor PR. Preliminary report on the results of nutrition prevention trials of cancer and other common diseases among residents in Linxian, China. Chung Hua Chung Liu Tsa Chih 1993;15:165-81.
- Gridley G, McLaughlin JK, Block G, et al. Vitamin supplement use and reduced risk of oral and pharyngeal cancer. Am J Epidemiol 1992;135:1083-92.
- Knekt P, Reunanen A, Jarvinen R, et al. Antioxidant vitamin intake and coronary mortality in a longitudinal population study. Am J Epidemiol 1994;139:1180-9.
- Bolton-Smith C, Woodward M, Tunstall-Pedoe H. The Scottish Heart Health Study. Dietary intake by food frequency questionnaire and odds ratios for coronary heart disease risk. II. The antioxidant vitamins and fibre. Eur J Clin Nutr 1992;45:85-93.
- Rimm EB, Stampfer MJ, Ascherio A, et al. Vitamin E consumption and the risk of coronary heart disease in men. N Engl J Med 1993;328:1450-6.
- Stampfer MJ, Hennekens CH, Manson JE, et al. Vitamin E consumption and the risk of coronary disease in women. N Engl J Med 1993;328:1444-9.
- Ginter E. Decline in coronary mortality in United States and vitamins C. Am J Clin Nutr 1979;32:511-2(letter)