Re: Vitamin E, heart disease and false logic...?
tcarter2_at_elp.rr.com
Date: 03/16/05
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Date: 16 Mar 2005 15:55:12 -0800
Hi,
Sbharris[atsign]ix.netcom.com wrote:
> Here's the abstract of the study, which is called HOPE-TOO (HOPE-The
> Ongoing Outcomes = HOPE-TOO . It's an ongoing bit of the HOPE trial
> (Heart Outcomes Prevention Evaluation). This is the biggest, longest
> prospective blinded and placebo-controlled prospective trial of
d-alpha
> tocopherol acetate. Basically, vitamin E per se as the d-alpha
> tocopherol has been found to do nothing particularly good in heart
> disease or diabetes. Worse than that, it increases chance of
congestive
> heart failure (albeit of a probably mild type). My comments are
> appended.
>
And in this study there was a 7% reduction in total mortality
despite the fact that the vit. E was given to a group in which 59% were
taking aspirin. As I've explained before both vit E and aspirin
antagonize vit K and BOTH independently cause blood thinning, internal
bleeding, and haemorrhagic stroke. The combination of the two together
in clinical trials always results in mildly unfavorable or null results
unless given with sufficient C (at least a two to one ratio) to swamp
the negative effects of the two ganging up on vit K, a vitamin of which
nearly everyone is deficient. Three trials of E alone have been done in
populations that don't take aspirin and all three showed benefits.
There is little or no inconsistency in the literature. Once more I will
spell it out for you.
Four trials of E with hi dose C-all favorable. These are the
only four.
Three trials of E without C or aspirin----- all favorable but
less so. I think these are the only ones. Can anyone prove me wrong?
Quite a few trials of E with people taking aspirin, or beta
carotene in smokers, or deprenyl (which is associated with excess
mortality in humans)-------UNfavorable.
This is the literature on the randomized, placebo controlled,
intervention trials of vit. E. This is the only place you will see it
properly summarized. I'm not too happy about supporting thousands of
clinical researchers with my tax dollars, and then having to do the
work myself. :>)
> "Effects of Long-term Vitamin E Supplementation on Cardiovascular
> Events and Cancer: A Randomized Controlled Trial" The HOPE and
HOPE-TOO
> Trial Investigators* JAMA, Vol. 293, pp. 1338-47 (March 15, 2005).
>
> ABSTRACT:
>
> Context: Experimental and epidemiological data suggest that Vitamin E
> supplementation
> may prevent cancer and cardiovascular events. Clinical trials have
> generally failed to confirm benefits, possibly due to their
relatively
> short duration.
>
> Objective: To evaluate whether long-term supplementation with Vitamin
E
> decreases the
> risk of cancer, cancer death, and major cardiovascular events.
>
> Design, Setting, and Patients: A randomized, double-blind,
> placebo-controlled international trial (the initial Heart Outcomes
> Prevention Evaluation [HOPE] trial conducted between December 21,
1993
> and April 15, 1999) of patients at least 55 years old with vascular
> disease or diabetes mellitus was extended (HOPE-The Ongoing Outcomes
> [HOPE-TOO]) between April 16, 1999 and May 26, 2003.
>
> Of the initial 267 HOPE centers that had enrolled 9,541 patients, 174
> centers participated in the HOPE-TOO trial. Of 7,030 patients
enrolled
> at these centers, 916 were deceased at the beginning of the
extension,
> 1,382 refused participation, 3,994 continued to take the study
> intervention, and 738 agreed to passive follow-up. Median duration of
> follow-up was 7.0 years.
>
> Intervention: Daily dose of natural source Vitamin E (400 IU)
[d-alpha
> tocopherol acetate] or matching placebo.
>
> Main Outcome Measures: Primary outcomes included cancer incidence,
> cancer deaths, and major cardiovascular events (myocardial
infarction,
> stroke, and cardiovascular death). Secondary outcomes included heart
> failure, unstable angina, and revascularizations.
>
> Results: Among all HOPE patients, there were no significant
> differences in the primary analysis: for cancer incidence, there were
> 552 patients (11.6%) in the Vitamin E group vs 586 (12.3%) in the
> placebo group (relative risk [RR], 0.94; 95% confidence interval
[CI],
> 0.84-1.06; P = .30); for cancer deaths, 156 (3.3%) vs 178 (3.7%),
> respectively (RR, 0.88; 95% CI, 0.71-1.09; P = .24); and for major
> cardiovascular events, 1022 (21.5%) vs 985 (20.6%), respectively (RR,
> 1.04; 95% CI, 0.96-1.14; P = .34). Patients in the Vitamin E group
had
> a higher risk of heart failure (RR, 1.13; 95% CI, 1.01-1.26; P = .03)
> and hospitalization for heart failure (RR, 1.21; 95% CI, 1.00-1.47; P
=
> .045). Similarly, among patients enrolled at the centers
participating
> in the HOPE-TOO trial, there were no differences in cancer incidence,
> cancer deaths, and major cardiovascular events, but higher rates of
> heart failure and hospitalizations for heart failure.
>
> Conclusion: In patients with vascular disease or Diabetes Mellitus,
> long-term Vitamin E supplementation does not prevent cancer nor major
> cardiovascular events and may increase the risk for heart failure.
>
>
> ==============================
>
>
> COMMENT by S. Harris:
>
> In the initial shorter duration version of the HOPE trial 3 years ago
> (>1800 patients per group), congestive heart failure (CHF) came
closest
> of any endpoint to being greater in the d-alpha tocopherol acetate
400
> IU group, with the RR 1.21 and confidence limits 1.0 - 1.46) p =
0.05.
> Hospitalization for CHF didn't come close to significance at p =
0.51.
> With larger numbers and longer followup, both these are now
significant
> in the HOPE-TOO.
>
> The interesting thing is that CHF is usually a consequence of
coronary
> disease and old MIs. But the number of MIs and other coronary events
> really didn't come close to being significantly altered by the
vitamin
> E in the full study above (which is the only one I have access to,
> right now). The closest of anything was stroke, which had a p of
0.2.
> None of the cardiac stuff was much different from RR =1, so it does
NOT
> look like it was there, but just isn't showing above the noise due to
> power problems.
>
> So what's going on? Of course I have no idea. But this kind of
> "congestive heart failure" is not as bad as it sounds to the layman,
if
> if doesn't increase deaths and doesn't result from any detectable
> increase in coronary events. It basically means retention of fluid in
> feet or lungs, and hospitalization means there's enough retention in
> the lungs to cause problems. We have no way to know if in this study,
> the extra cases were due to some global weakening of cardiac
function,
> or just some odd changes in salt handling and retention (which would
of
> course be less worrisome). We do know from this and many other
studies
> that blood pressure and renal function (at least, of the gross
> filtration sort) are not affected at all by doses of vitamin E in
this
> range. So it's a mystery. Still, I'm not going to pretend even this
> non-MI-related CHF is okay, although in many practices it would
simply
> mean an adjustment of diuretic. The bottom line is the only thing
> vitamin E does for cardiac patients we can really be sure of, is
> something (somewhat) bad.
Only in cohorts that are taking aspirin
> The main value of these studies is to show that vitamin E as the
> d-alpha form, in doses large enough to raise blood levels by 70%, has
> NO effect on heart disease progression. Or on diabetes progression.
Not
> even a hint of it, in a placebo controlled study of many thousands of
> people extending many years. I have a whole book (by Wilfred Shute,
> M.D. with Harald Taub: _Vitamin E for Ailing and Healthy Hearts_
1969,
> with the 11th paperback printing I have from 1977) claiming that this
> very d-alpha tocopherol in similar amounts, is a veritable cure-all
for
> all cardiac ailments. These claims by the Shute brothers go all the
way
> back to the 1940's. Every chapter of every health book since the
Shutes
> started blowing this horn, has had an enormous amount of junk
> repetition of all these claims.
>
> Well, these Shute claims appear to be wishful thinking. The real
shame
> is that it's taken the "medical establishment" half a century to
prove
> it. And no, there's still no good prospective evidence that vitamin E
> prevents cancer in humans, either. (Frankly, I'm a little more
hopeful
> that selenium will prove out, there. And possibly even vitamin C.)
> Vitamin E per se in reasonable and traditional supplemental amounts
> (which 400 IU is) certainly doesn't affect onset of diabetes, or
> progression of diabetic renal disease. We know that from the HOPE
trial
> also. I would have wagered a modest amount of money that this
wouldn't
> be so, from what I know of oxidative mechanisms in diabetes. But I'd
> have been wrong. That's why we do these studies.
>
> And no, the HOPE trial goes beyond showing that vitamin E just
doesn't
> heal the diseased-of-heart (though the Shutes claimed just that).
Most
> of the HOPE enrollees were not clinically ill, though they did have
> coronary disease. If vitamin E even slowed progression of those with
> disease, it would have been seen here. It wasn't. The idea that
vitamin
> E prevents ONSET of coronary disease in totally healthy people who
> don't have any at all (if such adults exist in our society), *even
> though* it doesn't at all effect progression of disease in people who
> already have some, is very far fetched. I think it's grasping at
> straws, in fact. I don't believe it, and can't imagine why anybody
> would.
Maybe because they read direct evidence of this theoretically
plausible fact that I posted. I doubt that you will be able to post any
evidence that it doesn't. See my comments on PMID 12090883 in
sci.life-extension. For those that don't understand the significance
of hi odds ratios in epidemiology I posted a short essay a while back.
> Here's the full text of the first phase of the HOPE trial, for the
> vitamin E side (as you know, there was another side looking at
> preventive effects of giving the ACE inhibitor ramepril).
>
> http://care.diabetesjournals.org/cgi/content/full/25/11/1919
>
> SBH
I've given seven gold standard, intervention trials on vit E and C,
referenced in previous posts, showing excellent cardiovascular and
mortality benefits when taken properly. I've made several public
claims that there are no negative trials without contradiction. If
these were drugs they would get FDA approval and be widely accepted.
Millions of people are dying annually of cardiovascular disease. I have
just one question for the medical community.
WHUTSWRONGWITCHYOUGUYS????
Thomas
- Next message: Andrew B. Chung, MD/PhD: "Re: Tacky brady syndrome"
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