Vitamin E for Cardiovascular Disease
Verdict: Safety Review
Across 7 PubMed studies, the evidence for Vitamin E in Cardiovascular Disease grades Tier D — counter-evidence. A safety signal is under review — see warnings below.
D 🔴 D Counter-Evidence Safety Review
Why this grade7-layer evidence engine
⚖️
Scoring transparency
All scores computed by a 7-layer evidence engine — fully auditableRaw score 0.20
D
C
B
A
S
← counter-evidence / ineffectiveeffective / strong evidence →
Final grade
D · Safety Review
Confidence
90%
Highly consistent evidence
Evidence level
E1
Cochrane high-quality SR/MA
▸View the full decision path (audit trail)
- compute_raw_score — 加權公式: L2×0.30 + L3×0.25 + L5×0.25 + L11×0.10 + L1×0.10 = 0.205
- tier_from_score — 依分數區間映射至 tier letter
- apply_hec_rules — 高品質 SR/MA 顯示 positive (1 篇 > 0 negative)
- tier_strict_requirement_check — Tier 條件達標，未降階
- detect_disputes — 偵測到 0 個 hard + 0 個 soft dispute
- decide_status — 依 tier + dispute 結果決定 status
PubMed studies (7)L2 · primary research & systematic reviews
Vitamin E supplementation and cardiovascular events in high-risk patients (HOPE trial)
Finding: In high-risk patients (with vascular disease or diabetes), vitamin E 400 IU/day for a mean 4.5 years had no effect on the primary composite cardiovascular endpoint (16.2% vs 15.5%, RR 1.05, 95% CI 0.95-1.16, P=0.33); no benefit on MI, stroke, or CV death individually.
View on PubMed Effects of long-term vitamin E supplementation on cardiovascular events and cancer: a randomized controlled trial (HOPE-TOO extension)
Finding: Long-term Vitamin E did NOT prevent cancer or major cardiovascular events. HARM SIGNAL: heart failure increased in Vit E group (RR 1.13, 95% CI 1.01-1.26, P=0.03) and hospitalization for heart failure also increased (RR 1.21, 95% CI 1.00-1.47, P=0.045). Authors concluded long-term Vit E may increase heart failure risk in patients with vascular disease or diabetes.
View on PubMed Dietary supplementation with n-3 polyunsaturated fatty acids and vitamin E after myocardial infarction: results of the GISSI-Prevenzione trial
Finding: Over 3.5 years in post-MI patients, vitamin E 300 mg/day showed NO significant benefit on the primary endpoint (RR 0.86 by 4-way analysis, NS) — explicitly stated 'vitamin E had no benefit'; the n-3 PUFA arm reduced events but the Vit E arm did not.
View on PubMed The effect of vitamin E and beta carotene on the incidence of lung cancer and other cancers in male smokers (ATBC Cancer Prevention Study)
Finding: Alpha-tocopherol did not reduce lung cancer or major cardiovascular events. HARM SIGNAL: more deaths from hemorrhagic stroke in the Vit E arm; beta-carotene arm showed increased lung cancer and overall mortality. Established the negative landmark for Vit E in smokers.
View on PubMed Controlled trial of alpha-tocopherol and beta-carotene supplements on stroke incidence and mortality in male smokers (Leppala, ATBC follow-up)
Finding: Over median 6 years in 28,519 male smokers, alpha-tocopherol modestly reduced cerebral infarction (~14%) but markedly INCREASED fatal subarachnoid hemorrhage by 181% (95% CI 37%-479%, P=0.01) and overall subarachnoid hemorrhage ~50%. Net effect on stroke was unfavorable in this population — landmark hemorrhagic stroke harm signal for Vit E.
View on PubMed Vitamins E and C in the prevention of cardiovascular disease in men: the Physicians' Health Study II randomized controlled trial (Sesso et al.)
Finding: Over mean 8 years, neither Vit E nor Vit C reduced major cardiovascular events, total MI, total stroke, or CV mortality. Vit E was associated with INCREASED hemorrhagic stroke (HR 1.74, 95% CI 1.04-2.91, P=0.04). The U.S. landmark primary-prevention RCT confirming no Vit E benefit.
View on PubMed Antioxidant supplements for prevention of mortality in healthy participants and patients with various diseases (Bjelakovic Cochrane review)
Finding: Pooled 78 RCTs (n=296,707): in low-risk-of-bias trials, Vit E significantly increased all-cause mortality (RR 1.03, 95% CI 1.00-1.05); 12.0% deaths in Vit E vs 10.3% controls. Authors concluded beta-carotene and Vitamin E 'seem to increase mortality.' No cardiovascular benefit demonstrated; signal of harm.
View on PubMed Regulatory & authoritative positionsL4/L5 · FDA / EMA / NIH ODS / Cochrane / Mayo …
L4a US FDA
Cautious
Some scientific evidence suggests that consumption of antioxidant vitamins may reduce the risk of certain forms of cancer. However, FDA has determined that this evidence is limited and not conclusive. source↗
L4b EU EFSA
Cautious
The effect on blood clotting and associated increased risk of bleeding is considered as the critical effect to establish an UL for vitamin E. ... The ULs for vitamin E from all dietary sources, which were previously established by the Scientific Committee on Food, are retained for all population groups source↗
L4c UK NHS
Cautious
You should be able to get all the vitamin E you need from your diet. Taking 540mg (800 IU) or less a day of vitamin E supplements is unlikely to cause any harm. If you take vitamin E supplements, do not take too much as this could be harmful. source↗
L4d TW TFDA / 衛福部
Cautious
其維生素E之總含量不得高於400I.U.（268mg d-α-tocopherol） source↗
L4e WHO
Cautious
Vitamin E and C supplementation is not recommended for pregnant women to improve maternal and perinatal outcomes. source↗
L5a NIH Office of Dietary Supplements
Cautious
Clinical trials have not provided evidence that routine use of vitamin E supplements prevents cardiovascular disease or reduces its morbidity and mortality. source↗
L5b Mayo Clinic
Against
Some studies suggest that certain vitamins, such as folic acid and vitamins C and E, may lower heart disease risk. But larger clinical trials haven't proved that. The American Heart Association and the U.S. Preventive Services Task Force don't advise taking vitamins to prevent heart disease. source↗
L5c Cleveland Clinic
Against
We don't have studies that confirm vitamin E supplements are a safe way to lower your risk of clots. If you're concerned about blood clots, talk to your healthcare provider. Don't just consider a vitamin E supplement the answer. source↗
L5d Harvard Health
Against
The U.S. Preventive Services Task Force's 2022 review of evidence from clinical trials found no conclusive benefit of vitamin E supplements for the prevention of cardiovascular disease, and therefore recommended against their use. source↗
L5e Specialty Society (condition-mapped)
Against
Avoid antioxidant vitamin supplements such as A, C and E. Scientific evidence does not support their benefit. source↗