Coronary artery disease: alpha-tocopherol reduced non-fatal myocardial infarction.

Clinical bottom line (level 1b)

  1. Patients with proven coronary artery disease who received alpha-tocopherol compared with placebo were less likely to have a non-fatal myocardial infarction (NNT = 35 at 1.4 years) .
  2. There was no clear effect on mortality.
Stephens et al: Lancet 1996; 347: 781-786
Expires March 2003

The study

Double-blinded concealed randomised trial with intention-to-treat
Setting: tertiary cardiac hospital, UK

2002 patients (aged mean 62, 84% male) with angiographically-proven coronary artery disease (90% with angina)

Excluded if
  • prior use of vitamins containing vitamin E


    • Control Group: (n = 967, 967 analysed): placebo
    Experimental Group: (n = 1035, 1035 analysed): alpha-tocopherol 800 IU daily

    100% followed for 1.4 years

    The evidence

    Outcome Time to outcome CEREERRRR
    (95% CI)    		ARR
    (95% CI)    		NNT
    (95% CI)
    non-fatal myocardial infarction 1.4 years 41
    (4.24%)    		 14
    (1.35%)    		 68%
    (42% to 82%)    		 2.89%
    (1,44% to 4.34%)    		 35
    (23 to 70)
    death 1.4 years 26
    (2.69%)    		 36
    (3.48%)    		 -29%
    (-113% to 21%)    		 -0.79%
    (-2.30% to 0.72%)    		 -130
    (NNT = 140 to infinity;
    NNH = 43 to infinity)

    Comments

    1. Three subsequent trials have examined the effects of Vitamin E in patients with coronary artery disease and none of these trials found that Vitamin E reduced cardiac or all-cause mortality.
    2. The role of Vitamin E in the prevention of cardiovascular disease remains unclear.

    Citation

    1. Stephens NG, Parsons A, Schofield PM, et al: randomised controlled trial of vitamin E in patients with coronary disease: Cambridge Heart Antioxidant Study (CHAOS). Lancet 1996; 347: 781-786
    Search Terms: ?
    Contributor: Chris Ball and Clare Wotton, February 2000
    Reviewer: Kenneth Ballew

    Clinical Question.
    Patient coronary artery disease
    Intervention or Exposure alpha-tocopherol
    Comparison placebo
    Outcome MI or death