Vitamin E: cautionary issues.

Compared with many medications used in the patient with cardiovascular disease, vitamin E is a relatively safe supplement. There are a few populations in which caution needs to be employed, however. Patients receiving warfarin therapy should be discouraged from using vitamin E supplements and should be closely monitored if they do. Smokers should avoid vitamin E due to potential negative effects on vitamin C, and vitamin E should never be administered in conjunction with beta-carotene in this population. The rare patient requiring vitamin A therapy or having retinitis pigmentosa should also avoid vitamin E supplementation. Because of the increased risk of bleeding, vitamin E should be discontinued in the perioperative period in any patient requiring surgery.