Editing Vitamin E (section)

=== Cardiovascular diseases ===
In a 2022 update of an earlier report, the [[United States Preventive Services Task Force]] recommended against the use of vitamin E supplements for the prevention of cardiovascular disease or cancer, concluding there was insufficient evidence to assess the balance of benefits and harms, yet also concluding with moderate certainty that there is no net benefit of supplementation.<ref name="Mangione2022" />

Research on the effects of vitamin E on [[cardiovascular disease]] has produced conflicting results. In theory, oxidative modification of [[Low-density lipoprotein|LDL-cholesterol]] promotes blockages in coronary arteries that lead to [[atherosclerosis]] and [[myocardial infarction|heart attacks]], so vitamin E functioning as an antioxidant would reduce oxidized cholesterol and lower risk of cardiovascular disease. Vitamin E status has also been implicated in the maintenance of normal endothelial cell function of cells lining the inner surface of arteries, anti-inflammatory activity and inhibition of [[platelet]] adhesion and aggregation.<ref name=Kirmizis2009>{{cite journal | vauthors = Kirmizis D, Chatzidimitriou D | title = Antiatherogenic effects of vitamin E: the search for the Holy Grail | journal = Vascular Health and Risk Management | volume = 5 | pages = 767–74 | date = 2009 | pmid = 19774218 | pmc = 2747395 | doi = 10.2147/vhrm.s5532 | doi-access = free | title-link = doi }}</ref> An inverse relation has been observed between [[coronary heart disease]] and the consumption of foods high in vitamin E, and also higher serum concentration of alpha-tocopherol.<ref name=Kirmizis2009 /><ref>{{cite journal | vauthors = Gaziano JM | title = Vitamin E and cardiovascular disease: observational studies | journal = Annals of the New York Academy of Sciences | volume = 1031 | issue = 1 |pages = 280–91 |date = December 2004 | pmid = 15753154 | doi = 10.1196/annals.1331.028 | bibcode = 2004NYASA1031..280G | s2cid = 26369772 }}</ref> The problem with observational studies is that these cannot confirm a relation between the lower risk of coronary heart disease and vitamin E consumption diets higher in vitamin E may also be higher in other, unidentified components that promote heart health, or lower in diet components detrimental to heart health, or people choosing such diets may be making other healthy lifestyle choices.<ref name=Kirmizis2009 />

A meta-analysis of [[randomized clinical trial]]s (RCTs) reported that when consumed without any other antioxidant nutrient, the relative risk of heart attack was reduced by 18%.<ref name=Loffredo2015>{{cite journal | vauthors = Loffredo L, Perri L, Di Castelnuovo A, Iacoviello L, De Gaetano G, Violi F | title = Supplementation with vitamin E alone is associated with reduced myocardial infarction: a meta-analysis | journal = Nutrition, Metabolism, and Cardiovascular Diseases | volume = 25 | issue = 4 | pages = 354–63 | date = April 2015 | pmid = 25779938 | doi = 10.1016/j.numecd.2015.01.008 }}</ref> However, two large trials that were incorporated into the meta-analysis either did not show any benefit for heart attack, stroke, coronary mortality or all-cause mortality,<ref name=Sesso2008>{{cite journal | vauthors = Sesso HD, Buring JE, Christen WG, Kurth T, Belanger C, MacFadyen J, Bubes V, Manson JE, Glynn RJ, Gaziano JM |title = Vitamins E and C in the prevention of cardiovascular disease in men: the Physicians' Health Study II randomized controlled trial | journal = JAMA |volume = 300 |issue = 18 |pages = 2123–33 | date = November 2008 | pmid = 18997197 | pmc = 2586922 | doi = 10.1001/jama.2008.600 }}</ref> or else a higher risk of heart failure in the alpha-tocopherol group.<ref>{{cite journal | vauthors = Lonn E, Bosch J, Yusuf S, Sheridan P, Pogue J, Arnold JM, Ross C, Arnold A, Sleight P, Probstfield J, Dagenais GR | title = Effects of long-term vitamin E supplementation on cardiovascular events and cancer: a randomized controlled trial | journal = JAMA | volume = 293 | issue = 11 | pages = 1338–47 | date = March 2005 | pmid = 15769967 | doi = 10.1001/jama.293.11.1338 | doi-access = free | title-link = doi }}</ref>

Vitamin E supplementation does not reduce the incidence of [[Brain ischemia|ischemic]] or [[Intracerebral hemorrhage|hemorrhagic]] [[stroke]].<ref>{{cite journal | vauthors = Bin Q, Hu X, Cao Y, Gao F | title = The role of vitamin E (tocopherol) supplementation in the prevention of stroke. A meta-analysis of 13 randomized controlled trials | journal = Thrombosis and Haemostasis| volume = 105 | issue = 4 | pages = 579–85 | date = April 2011 | pmid = 21264448 | doi = 10.1160/TH10-11-0729 | s2cid = 23237227 }}</ref><ref name=Maggio2024/> However, supplementation of vitamin E with other antioxidants reduced risk of ischemic stroke by 9% while increased the risk for hemorrhagic stroke by 22%.<ref name=Maggio2024>{{cite journal |vauthors=Maggio E, Bocchini VP, Carnevale R, Pignatelli P, Violi F, Loffredo L |title=Vitamin E supplementation (alone or with other antioxidants) and stroke: a meta-analysis |journal=Nutr Rev |volume=82 |issue=8 |pages=1069–78 |date=August 2024 |pmid=37698992 |doi=10.1093/nutrit/nuad114 |url=}}</ref>

==== Denial of cardiovascular health claims ====
In 2001, the U.S. [[Food and Drug Administration]] rejected proposed health claims for vitamin E and cardiovascular health.<ref>{{cite web |url=https://www.fda.gov/Food/IngredientsPackagingLabeling/LabelingNutrition/ucm073251.htm |archive-url=https://wayback.archive-it.org/7993/20171115122059/https://www.fda.gov/Food/IngredientsPackagingLabeling/LabelingNutrition/ucm073251.htm |url-status=dead |archive-date=15 November 2017 |title=Letter regarding dietary supplement health claim for vitamin E and heart disease (Docket No 99P-4375) |website=U.S. Food and Drug Administration |access-date=24 August 2018}}</ref> The U.S. National Institutes of Health reviewed literature published up to 2008 and concluded "In general, clinical trials have not provided evidence that routine use of vitamin E supplements prevents cardiovascular disease or reduces its morbidity and mortality."<ref name="GOVe" /> The [[European Food Safety Authority]] (EFSA) reviews proposed health claims for the [[European Union]] countries. In 2010, the EFSA reviewed and rejected claims that a cause and effect relationship has been established between the dietary intake of vitamin E and maintenance of normal cardiac function or of normal blood circulation.<ref>{{cite journal |doi=10.2903/j.efsa.2010.1816 |title=Scientific Opinion on the substantiation of health claims related to vitamin E and protection of DNA, proteins and lipids from oxidative damage (ID 160, 162, 1947), maintenance of the normal function of the immune system (ID 161, 163), maintenance of normal bone (ID 164), maintenance of normal teeth (ID 164), maintenance of normal hair (ID 164), maintenance of normal skin (ID 164), maintenance of normal nails (ID 164), maintenance of normal cardiac function (ID 166), maintenance of normal vision by protection of the lens of the eye (ID 167), contribution to normal cognitive function (ID 182, 183), regeneration of the reduced form of vitamin C (ID 203), maintenance of normal blood circulation (ID 216) and maintenance of normal a scalp (ID 2873) pursuant to Article 13(1) of Regulation (EC) No 1924/2006 |journal=EFSA Journal |volume=8 |issue=10 |pages=1816 |year=2010 | doi-access = free | title-link = doi }}</ref>