Complementary Alternative Cardiovascular Medicine

Chapter 5 / Vitamin Therapy and CVD 63
trolled open 2 × 2 factorial trial to investigate the effects of 100 mg
aspirin and 300 mg vitamin E in the CVD events.
The RDA for vitamin E for men and women is 15 mg/d and the UL
is 1000 mg/d (12).
CONCLUSION STATEMENT
Vitamin E intake has been associated with decreased risk for cardiovascular
death and nonfatal MI in cohort and cross-sectional studies and
in trials with relatively healthy subjects consuming ≥ 100 IU vitamin E/d
for at least 2 yr. However, there was no significant effect of vitamin E
supplementation (400 and 600 IU/d) during 4–6 yr in high-risk patients.
Grade II: The conclusion is supported by fair evidence.
β-Carotene
β-carotene inhibits oxidation of LDL and Lp(a) (24). Smokers have
lower LDL β-carotene levels relative to nonsmokers. However, the
Physicians’ Health Study did not demonstrate benefit from 50 mg β-carotene
supplementation on alternate days when compared to placebo (25).
The ATBC trial showed that β-carotene supplementation with 20 mg/d
increased total mortality and lung cancer significantly and showed a
nonsignificant increase in mortality from CVD after 6.5 yr of supplementation.
The Beta-Carotene and Retinol Efficacy Trial (CARET) was stopped
21 mo early because the β-carotene group had 285 more lung cancer
cases and 17% more deaths than the control group (26). Cardiovascular
mortality was also increased in the β-carotene group.
CONCLUSION STATEMENT
Randomized studies assessing supplementation with β-carotene have
shown no benefit; in smokers, the risk of developing lung cancer and
overall mortality increased.
Folate and Vitamins B 6 and B 12
Elevated levels of homocysteine (Hcy) in the bloodstream have been
associated with an increased risk of CVD (27). Clinical studies have
linked moderate hyperhomocysteinemia to peripheral vascular, cerebrovascular,
and coronary heart disease (CHD). These metabolic defects
can be related to genetic reasons or nutritional deficiency of vitamin B 6
or B 12 or folate that are cofactors to the enzymes in Hcy metabolism (28).
A prospective study of male physicians indicated that plasma Hcy
concentrations of 17 µmol/L or 12% more than the UL of normal were
associated with a threefold to fourfold increase in the risk of acute myo-