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50 mg «-tocopherol and/or 20 mg ^-carotene

300 or 800IU «-tocopherol

300 mg a-tocopherol and/or 1 g n-3 PUFA 400 IU a-tocopherol and/or ACE inhibitor 20 mg ^-carotene, 600 mg a-tocopherol, and 250 mg vitamin C

No effect on total coronary events (fatal and nonfatal) Increase in deaths from fatal CHD in ^-carotene (+75%) and combined ^-carotene/vitamin E group (+58%) vs placebo No effect on symptoms or progression of angina or on total coronary events Reduction in nonfatal MI (-77%) but no effect on CVD mortality

No benefit from vitamin E

No effect on MI, stroke, or CVD death

No effect on fatal or nonfatal MI or stroke aSecondary prevention is defined as including patients with known or documented vascular disease.

ACE, angiotensin converting enzyme; ATBC, Alpha Tocopherol Beta Carotene Prevention Study; CHAOS, Cambridge Heart Antioxidant Study; GISSI, GISSI Prevenzione Trial; HOPE, Heart Outcomes Prevention Evaluation Study; HPS, Heart Protection Study; CHD, Coronary Heart Disease; CVD, cardiovascular disease; MI, myocardial infarction; PUFA, polyunsatutated fatty acids.

supplementation with a cocktail of antioxidant vitamins (600 mg vitamin E, 250 mg vitamin C, and 20 mg ^-carotene) alone or in combination with the lipid-lowering drug Simvastatin or placebo in more than 20 000 adults with CHD, other occlusive arterial disease, or diabetes mellitus. Although blood levels of antioxidant vitamins were substantially increased, no significant reduction in the 5-year mortality from vascular disease or any other major outcome was noted. In the Italian GISSI-Prevenzione Trial dietary fish oils reduced the risk of fatal or nonfatal CVD in men and women who had recently suffered from a heart attack but vitamin E supplementation (300 mg daily for 32years) did not provide any benefit. In these three trials, no significant adverse effects of vitamin E were observed.

Systematic reviews and meta-analyses of the clinical trials to date have therefore concluded that despite evidence from observational studies, people with a high occurrence of CVD often have low intakes or plasma levels of antioxidant nutrients. Supplementation with any single antioxidant nutrient or combination of nutrients has not demonstrated any benefit for the treatment or prevention of CVD.

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