Does vitamin E prevent heart disease?

What the large reviews found

A 2022 review for the US Preventive Services Task Force pooled trials in adults without heart disease. Vitamin E did not change the number of heart and blood vessel events (4 trials, 62,136 people) or deaths from any cause (9 trials, 107,772 people).^[1] The Task Force concluded with moderate certainty that vitamin E has no net benefit for preventing heart disease or cancer.^[3]

A 2022 review of 884 trials of 27 nutrients found that vitamin E had no effect on the risk of heart disease or type 2 diabetes.^[2]

What the largest trials found

• HOPE and HOPE-TOO: 9,541 people aged 55 or older with vascular disease or diabetes took 400 IU of natural vitamin E a day or a placebo. They were followed for a median of 7 years. Major heart events occurred in 21.5% with vitamin E and 20.6% with placebo. Heart failure was 13% more common with vitamin E.^[5]
• Women's Health Study: 39,876 healthy women aged 45 or older took 600 IU of natural vitamin E every other day for about 10 years. Major heart events did not change, but deaths from heart disease were 24% lower.^[6]
• Physicians' Health Study II: 14,641 male doctors aged 50 or older took 400 IU every other day for 8 years. Major heart events did not change, and hemorrhagic strokes were 74% more common.^[7]
• CHAOS: 2,002 people with narrowed heart arteries took 400 or 800 IU a day or a placebo and were followed for a median of 510 days. There were 14 non-fatal heart attacks with vitamin E against 41 with placebo, but deaths from heart disease did not fall: 27 with vitamin E and 23 with placebo.^[8]

What happened to strokes

A 2010 review of 9 trials with 118,765 people found no change in the total number of strokes. Vitamin E raised the risk of hemorrhagic stroke by 22% and lowered the risk of ischemic stroke, the kind caused by a clot, by 10%.^[4] In numbers, that is 1 extra hemorrhagic stroke for every 1,250 people who take vitamin E, and 1 ischemic stroke prevented for every 476.^[4] A 2024 review of 16 trials found no effect on either kind of stroke when vitamin E was taken alone. With other antioxidants, vitamin E lowered ischemic strokes by 9% and raised hemorrhagic strokes by 22%.^[9]

Results that point the other way

A 2015 review of 16 trials found fewer heart attacks when vitamin E was taken alone: 3.0% against 3.4% (relative risk 0.82). It found no effect when vitamin E was taken with other antioxidants.^[10] In the Women's Health Study, women who took vitamin E had 21% fewer blood clots in the veins, an outcome the trial measured in addition to its main ones.^[11] The reviews of all heart outcomes did not find a benefit.^[1][2]

Why the idea did not hold

In lab studies, vitamin E stops the oxidation of LDL cholesterol, a step thought to start the build-up of plaque in arteries.^[12] Observational studies linked high vitamin E intake to less heart disease, but trials that gave vitamin E did not confirm this.^[12] Most trials were in middle-aged and older people with heart disease or its risk factors. The effect in younger, healthy people is unknown.^[12]

Who should be careful

Large doses of vitamin E can add to the effect of blood thinners such as warfarin and raise the risk of bleeding.^[12] EFSA set an upper limit of 300 mg a day. It says this limit does not apply to people who take blood thinners or aspirin. It also does not apply to people treated to prevent a second heart attack or stroke.^[13] People in these groups should ask a doctor or pharmacist before they take vitamin E.^[12]