Vitamin E And Heart Disease

Written by Dr. Steve Chaney on . Posted in current health articles, Supplements and Health, Vitamins and Health

Does Vitamin E Reduce Heart Attack Risk?

Author: Dr. Stephen Chaney

vitamin e and heart diseaseSince February is “Heart Health Month”, I thought I would share some information with you that might change how you think about vitamin E and heart disease risk. You’ve seen the headlines: “Vitamin E Does Not Reduce the Risk of Heart Disease”. In fact, these headlines have been repeated so many times that virtually every expert thinks that it has to be true. Let me share the opinion of one expert who disagrees. This week I’m going to share some information with you that I learned from a seminar by Dr. Jeffrey Blumberg from Tufts University.

But first let me tell you who Dr. Blumberg is. Dr. Blumberg is a Professor in the Friedman School of Nutrition Science and Policy at Tufts. Dr. Blumberg has over 200 publications in peer-reviewed scientific journals. He is considered one of the world’s top experts on supplementation.

Now back to what I learned at his seminar. Dr. Blumberg’s specialty is conducting and analyzing clinical studies, and his perspective on some very influential clinical studies is a bit different from what you may have heard from media reports. He believes that the media has seriously misinterpreted several recent studies. You might call this “The Rest of the Story” because you (and your doctor) definitely did not hear this part of the story in the news.

Does Vitamin E Reduce Heart Disease Risk In Women?

cardiovascular disease in womenLet’s start with vitamin E and the risk of cardiovascular disease in women. The most influential study on this subject was the Women’s Health Study (Lee et al., JAMA, 294:56-65, 2005). This was a major study in which 39,876 women were given either 600 IU of vitamin E every other day or a placebo and followed for 10 years.

The headlines said “Vitamin E Supplements Do Not Reduce Risk Of Cardiovascular Death, Heart Attack And Stroke In Women”. That was true if you looked at the total population of women in the study.

But Dr. Blumberg pointed out that when you looked at women who were 65 or older in that study vitamin E supplementation caused a…

  • 24% decrease in cardiovascular deaths,
  • 26% decrease in major cardiovascular events,
  • 21% decrease in venous thromboembolism (blood clots forming in the veins),

…and all of these decreases were statistically highly significant. That’s important because the risk of heart disease in pre-menopausal women is extremely low. It’s the over 65 group who have a high risk of heart disease.

Perhaps the headlines should have said: “Vitamin E reduces the risk of cardiovascular disease and cardiovascular deaths in those women at high risk of heart attacks”. But, of course, they didn’t. Perhaps that wasn’t considered newsworthy.

Other Studies On Vitamin E and Heart Disease Risk In Women

heart disease riskIf this were the only study suggesting the vitamin E might benefit women at high risk of having a heart attack or stroke, it might be easy to dismiss it, but it’s not the only study showing this effect.

For example, a subsequent study called the “Women’s Antioxidant Cardiovascular Study” looked at the effect of 600 IU of vitamin E every other day on cardiovascular events in 8171 women health professionals (Cook et al, Archives of Internal Medicine, 167:1610-1618, 2007).

Once again the headlines said that vitamin E supplementation had no effect on cardiovascular events in women. But, when the authors looked at those women who already had cardiovascular disease at the beginning of the study (and were, therefore, at high risk of suffering a cardiovascular event during the study) vitamin E supplementation caused a 23% decreased risk of heart attack, stroke and cardiovascular death.

Another important study was the HOPE (Heart Outcomes Prevention Evaluation) study (Levy et al, Diabetes Care, 27: 2767, 2004). The overall study results were similar to several other recent trials – no significant effect of vitamin E supplementation on cardiovascular health in the population group as a whole.

However, by the time that study was performed it was clear that a particular genetic variation in the haptoglobin gene called the haptoglobin 2-2 genotype lead to a significant increase in oxidative damage to the vascular wall (the professor will collect your quizes at the end of this email).

When the data were reanalyzed by genotype, it became clear that people with the haptoglobin 2-2 genotype experienced a significant decrease in both heart attack and cardiovascular death with vitamin E supplementation. This finding has been confirmed by a subsequent double-blind, placebo-control study specifically designed to look at the cardioprotective effects of vitamin E in people with different haptoglobin genotypes (Milman et al, Arterioscler. Thromb. Vasc. Biol., 24: 136, 2008).

In short, the headlines from all three studies should have said: “Vitamin E reduces the risk of cardiovascular disease and cardiovascular deaths in those women at high risk of heart attacks” – and, it doesn’t appear to matter whether the increased risk is due to age, pre-existing disease, or genetic predisposition.

Does Vitamin E Reduce Heart Disease Risk In Men?

heart disease in menFor men the most influential study was called the “Physician’s Health Study II” (H. D. Sesso et al, JAMA, 300: 2123-2133, 2008). In this study male physicians aged 40-84 were invited to participate in a double-blind clinical trial in which they were randomly assigned into groups who were given 400 IU of vitamin E every other day or placebo. They were followed for an average of 8 years during which data on both total mortality and cardiovascular mortality were obtained.

Once again, the headlines read “Vitamin E Does NotPrevent Cardiovascular Disease in Men”. But let me tell you what Dr. Blumberg said so that you understand “The Rest of the Story”. It starts by looking at the selection process for the Physician Health Studies.

Dr. Sesso and his colleagues sent out a letter asking 261,248 male physicians in the US if they would be willing to participate in the study. Only 112,528 responded and, of those responding, only 59,272 indicated that they were willing to participate. Of those who said that they were willing to participate only 32,223 met the selection criteria.

The exclusion criteria eliminated anyone who already had suffered a heart attack, stroke, angina or was on a blood thinner – in other words those people who were at greatest risk of suffering a heart attack or stroke during the study.

Finally, the study had an 18 week “run in” period to eliminate those people who were unwilling or unable to comply with the study protocol. This eliminated another 10,000 participants, leaving only 22,071 participants – less than 10% of the original.

This is where it gets really interesting. Dr. Sesso and his colleagues used publicly available databases to evaluate total and cardiovascular mortality in each group (H. D. Sesso et al, Controlled Clinical Trials, 23: 686-702, 2002). It turns out that at each stage of the selection process the incidence of both total and cardiovascular mortality during the 8-year period decreased.

In fact, the doctors who were actually included in the study were 67% less likely to die from all causes and 73% less likely to die from cardiovascular disease than the male physician population as a whole.

The bottom line is that the selection process eliminated almost all of the physicians at significant risk of having a heart attack or stroke during the study. The only ones who were actually enrolled in the study were those physicians who were at very low risk for having a fatal heart attack or stroke – or dying from any cause – during the study.

So the headlines describing this study should have read “Vitamin E Does Not Prevent Cardiovascular Disease in Men Who Are At Very Low Risk Of Heart Attack And Stroke”.The irony is that there was nothing wrong with the design of the study. It’s probably just a male ego thing. Guys who were unhealthy just didn’t want to participate in a study that might show how unhealthy they really were.

What Does This Mean For You?

These studies illustrate the true story of supplementation. For those of us who are at low risk of disease, supplementation is just a form of health insurance. But for those of us at high risk of disease, supplementation can make a huge difference in our health. That increased risk can be due to many things, as we have seen in the studies above. It can be due to poor diet, age, pre-existing disease, and/or genetic predisposition.

The problem is that most of us don’t really know whether we are at low risk or high risk until it’s too late. For millions of Americans the first sign of heart disease is sudden death.

 

The Bottom Line

  • The experts have been saying for years that vitamin E does not reduce the risk of heart disease. That claim is true, if you look at the general population, most of which is at low risk of developing heart disease – at least during the time frame of the clinical studies. However, when you look at people who are at high risk of developing heart disease, the answer is different.
  • For example, when you look at clinical studies with women, vitamin E significantly decreased the risk of heart attacks in women who…
  • Were over 65,
  • Had pre-existing heart disease at the beginning of the study,
  • Or, had a genetic predisposition to heart disease.

The headlines from these studies should have read “Vitamin E reduces the risk of cardiovascular disease in those women at high risk of heart attacks”, but they didn’t.

  • For men the story is a bit different. The Physician’s Health Study is considered the definitive study on the subject. However, most of the unhealthy male physicians either didn’t enroll in the study or dropped out before its completion. In fact, the doctors who were actually included in the study were 67% less likely to die from all causes and 73% less likely to die from cardiovascular disease than the male physician population as a whole. The headlines describing this study should have read “Vitamin E Does Not Prevent Cardiovascular Disease in Men Who Are At Very Low Risk Of Heart Attack And Stroke”.
  • These studies illustrate the true story of supplementation. For those of us who are at low risk of disease, supplementation is just a form of health insurance. But for those of us at high risk of disease, supplementation can make a huge difference in our health. That increased risk can be due to many things, as we have seen in the studies above. It can be due to poor diet, age, pre-existing disease, and/or genetic predisposition.
  • The problem is that most of us don’t really know whether we are at low risk or high risk until it’s too late. For millions of Americans the first sign of heart disease is sudden death.

 

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

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The Truth About Vitamin D

Posted December 11, 2018 by Dr. Steve Chaney

Does Vitamin D Reduce Risk Of Heart Disease & Cancer?

Author: Dr. Stephen Chaney

 

the truth about vitamin dYou have every right to be confused. One day you are told that vitamin D reduces your risk of heart disease and cancer. The next day you are told vitamin D makes has no effect on those diseases. You are told vitamin D is a waste of money. What should you believe?  What is the truth about vitamin D?

In mid-November a major clinical study called VITAL was published. It examined the effect of vitamin D and omega-3s on heart disease and cancer risk. Last week I wrote about the omega-3 portion of the study. This week I will cover the vitamin D portion of the study.

Once again, if you rely on the media for your information on supplementation, you are probably confused. Headlines ranged from “Vitamin D Is Ineffective For Preventing Cancer And Heart Disease to “Vitamin D Lowers Odds Of Cancer Death.” What is the truth?

The problem is that reporters aren’t scientists. They don’t know how to interpret clinical studies. What they report is filtered through their personal biases. That is why I take the time to carefully evaluate the clinical studies, so I can provide you with accurate information. Let me sort through the dueling headlines and give you the truth about vitamin D, cancer, and heart disease.

How Was The Study Designed?

the truth about vitamin d studyThe VITAL study (JE Manson et al, New England Journal of Medicine, DOI: 10.1056/NEJMoa1811403) enrolled 25,871 healthy adults (average age = 67) in the United States. The study participants were 50% female, 50% male, and 20% African American. None of the participants had preexisting cancer or heart disease. The characteristics of the study group were typical of the American population at that age, namely:

  • The average BMI was 28, which means that most of the participants were significantly overweight.
  • 7% of them had diabetes.

Study participants were given questionnaires on enrollment to assess clinical and lifestyle factors including dietary intake. Blood samples were taken from about 65% of the participants to determine 25-hydroxyvitamin D levels (a measure of vitamin D status) at baseline and at the end of the first year. The participants were given either 2,000 IU of vitamin D/day or a placebo and followed for an average of 5.3 years.

There were two important characteristics of the participants in this study that may have influenced the outcome.

  • The average 25-hydroxyvitamin D level of participants at the beginning of the study was 31 ng/ml (78 nmol/L). The NIH considers 20-50 ng/ml (50-125 nmol/L) to be the optimal level of 25-hydroxyvitamin D for most physiological functions. This means that study participants started in the middle of the optimal range with respect to vitamin D status.

[Note: The NIH defines the 20-50 ng/ml range as “adequate.”  However, I know many of my readers like to aim beyond adequate to reach what they consider to be “optimal.”  In the case of vitamin D, that might not be a good idea. The NIH considers anything above 50 ng/ml as associated “with potentially adverse effects.”  For that reason, I will refer to the 20-50 ng/ml range as optimal for this article. I wouldn’t want to encourage my readers to be aiming for above 50 ng/ml.]

  • Only 12.7% of participants had 25-hydroxyvitamin D levels below 20 ng/ml, which the NIH considers to be inadequate. The results with this group were not statistically different from the study participants with optimal vitamin D status, but it is not clear that there were enough people in this subgroup for a statistically valid comparison with participants starting with an optimal vitamin D status.
  • At the end of the first year, 25-hydroxyvitamin D levels in the treatment group increased to 42 ng/ml (105 nmol/L), which is near the upper end of the optimal range. Thus, for most of the participants, the study was evaluating whether there was a benefit of increasing vitamin D status from the middle to the upper end of the optimal range.
  • The study allowed subjects to continue taking supplements that contained up to 800 IU of vitamin D. While the authors tried to correct for this statistically, it is a confounding variable.

Does Vitamin D Reduce The Risk Of Cancer?

 

the truth about vitamin d and cancerYou may remember from last week that omega-3s were more effective for reducing heart disease risk than for reducing cancer risk. What is the truth about vitamin D and cancer risk?   The results are reversed for vitamin D, so I will discuss cancer first.

The study reported that vitamin D supplementation did not reduce a diagnosis of invasive cancer of any type, breast cancer, prostate cancer, or colon cancer during the 5.3-year time-period of this study. This was the result that was reported in the abstract and was what lazy journalists, who never read past the abstract, reported.

However, the rest of the study was more positive. For example, occurrence of invasive cancer of any type was reduced by:

  • 23% in African-Americans.
  • 24% in patients with a healthy body weight.

Several previous studies have suggested that vitamin D may be more effective at preventing cancer in people with a healthy body weight, but the mechanism of this effect is currently unknown.

Most previous studies have not included enough African-Americans to determine whether they respond more favorably to vitamin D supplementation. However, African-Americans have a higher risk of cancer, so this finding deserves follow-up.

In addition, when the study looked at deaths from cancer, the results were very positive. For example:

  • Cancer deaths during the 5.3-year study period were reduced by 17%.
  • The longer vitamin D supplementation was continued the more effective it became at reducing cancer deaths. For example,
  • When the authors excluded cancer deaths occurring during the first year of supplementation, vitamin D reduced cancer deaths by 21%.
  • When the authors excluded cancer deaths occurring during the first two years of supplementation, vitamin D reduced cancer deaths by 25%.

Finally, no side effects were noted in the vitamin D group.

 

Does Vitamin D Reduce The Risk Of Heart Disease?

 

the truth about vitamin d and heart diseaseThe VITAL study also looked at the effect of vitamin D on heart disease risk. What is the truth about vitamin D and heart disease?  The results from this study were uniformly negative. There was no effect of vitamin D supplementation on all major cardiovascular events combined, heart attack, stroke, or death from heart disease. Does that mean vitamin D has no role in reducing heart disease risk? That’s not clear.

The authors had a thought-provoking explanation for why the results were negative for heart disease, but positive for cancer. Remember that the participants in this trial started with a 25-hydroxyvitamin D level of 31 ng/ml and increased it to at least 42 ng/ml with vitamin D supplementation.

The authors stated that previous studies have suggested the 25-hydroxyvitamin D level associated with the lowest risk for heart disease is between 20 and 25 ng/ml. If that is true, most of the participants in this trial were already in the lowest possible risk for heart disease with respect to vitamin D status before the study even started. There would be no reason to expect additional vitamin D to further reduce their risk of heart disease.

In contrast, the authors said that previous studies suggest the 25-hydroxyvitamin D level associated with the lowest risk of cancer deaths is above 30 ng/ml. If that is true, it would explain why vitamin D supplementation in this study was effective at reducing cancer deaths.

However, previous placebo-controlled clinical studies have also been inconclusive with respect to vitamin D and heart disease. My recommendation would be to think of adequate vitamin D status as part of a holistic approach to reducing heart disease – one that includes a heart-healthy diet and a heart-healthy lifestyle – rather than a “magic bullet” that decreases heart disease risk by itself.

As for heart-healthy diets, I discuss the pros and cons of various diets in my book, “Slaying The Food Myths.”  As I discuss in my book, the weight of scientific evidence supports primarily plant-based diets that include omega-3s as heart healthy. As an example, the Mediterranean diet is primarily plant-based and is rich in healthy oils like olive oil and omega-3s. It is associated with reduced risk of both heart disease and cancer.

 

What Is The Truth About Vitamin D?

 

the truth about vitamin d signThere is a lot of confusion around the question of whether vitamin D reduces the risk of cancer. This study strengthened previous observation suggesting that vitamin D supplementation decreases cancer deaths. However, it is also consistent with previous studies that have failed to find an effect of vitamin D on cancer development. How can we understand this apparent discrepancy? The authors provided a logical explanation. They pointed out that:

  • Cancer development takes 20-30 years while this clinical study lasted only 5.3 years. That means that vitamin D supplementation only occurred at the tail end of the cancer development process. In fact, the cancer was already there in most of the patients in the study who developed cancer. It just had not been diagnosed yet. In the words of the authors: “Given the long latency for cancer development, extended follow-up is necessary to fully ascertain potential effects [of vitamin D supplementation].”
  • In contrast, none of the patients had been diagnosed with cancer when they entered the trial. That means that the patients were diagnosed with cancer during the 5.3-year study period. They were receiving extra vitamin D during the entire period of cancer treatment. Thus, the effect of vitamin D on reducing cancer deaths was easier to detect.

What Does This Study Mean For You?

the truth about vitamin d questionsVitamin D Is Likely To Decrease Your Risk Of Dying From Cancer: When you combine the results of this study with what we already know about vitamin D and cancer, the results are clear. Vitamin D appears to reduce your risk of dying from cancer. More importantly, the longer you have been supplementing with vitamin D, the greater your risk reduction is likely to be.

Vitamin D May Decrease Your Risk Of Developing Cancer: Association studies suggest that optimal vitamin D status is associated with decreased cancer risk, especially colon cancer risk. However, the long time for cancer development means that we may never be able to prove this effect through double-blind, placebo-controlled clinical trials.

Holistic Is Best: When you combine the VITAL study results with what we already know about vitamin D and heart disease, it appears that supplementing with vitamin D is unlikely to reduce your risk of developing heart disease unless you are vitamin D deficient. However, a holistic approach that starts with a healthy, primarily plant-based diet and makes sure your vitamin D status is adequate is likely to be effective.

The same is likely true for cancer. While the latest study suggests that vitamin D supplementation reduces your risk of dying from cancer, those vitamin D supplements are likely to be even more effective if you also adopt a healthy diet and lifestyle.

How Much Vitamin D Do You Need? The optimal dose of vitamin D is likely to be different for each of us. One of the things we have learned in recent years is that there are significant differences in the efficiency with which we convert vitamin D from diet and/or sun exposure into the active form of vitamin D in our cells. Fortunately, the blood test for 25-hydroxyvitamin D is readily available and is widely considered to be an excellent measure of our vitamin D status.

I recommend that you have your blood level of 25-hydroxyvitamin D tested on an annual basis. Based on the best currently available data, I recommend you aim for >20 ng/ml (50 nmol/L) if you wish to minimize your risk of heart disease and >30 ng/ml (75 nmol/L) if you wish to minimize your risk of cancer. If you can achieve those levels through diet and a multivitamin supplement, that is great. If not, I would recommend adding a vitamin D supplement until those levels are achieved.

Finally, you shouldn’t think of vitamin D as a magic bullet. If you are a couch potato and eat sodas and junk food, don’t expect vitamin D to protect you from cancer and heart disease. You should think of maintaining adequate 25-hydroxyvitamin D levels as just one component of a holistic approach to healthy, disease-free living.

 

The Bottom Line

 

There is a lot of confusion around the question of whether vitamin D reduces the risk of cancer and heart disease. A major clinical study has just been published that sheds light on these important questions. It reported:

  • Vitamin D did not decrease the risk of developing cancer during the 5.3-year study duration. The authors pointed out that cancer takes 20-30 years to develop, which means their study was probably too short to detect an effect of vitamin D on the risk of developing cancer.
  • Vitamin D did decrease the risk of dying from cancer, and the longer people were supplementing with vitamin D the bigger the protective effect of vitamin D was.
  • Vitamin D did not decrease the risk of heart disease. However, most study participants had a level of 25-hydroxyvitamin D that was optimal for reducing the risk of heart disease at the beginning of the study. There was no reason to expect that extra vitamin D would provide additional benefit.
  • With respect to both cancer and heart disease the best advice is to:
    • Get your 25-hydroxyvitamin D levels tested on an annual basis and supplement, if necessary, to keep your 25-hydroxyvitamin D levels in what the NIH considers to be an adequate range (20-50 ng/ml).
    • We do not have good dose response data for the beneficial effects of vitamin D on heart disease and cancer. However, according to this article, previous studies suggest you may want to am for 25-hydroxyvitamin D levels above 20 ng/ml to reduce the risk of heart disease and above 30 ng/ml to reduce your risk of cancer.
    • Consider vitamin D as just one component of a holistic approach to healthy, disease-free living.

For more details about the interpretation of these studies and what they mean for you, read the article above.

 

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

 

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