Stampfer M J, Hennekens C H, Manson J E, Colditz G A, Rosner B, Willett W C
Channing Laboratory, Boston, MA 02115.
N Engl J Med. 1993 May 20;328(20):1444-9. doi: 10.1056/NEJM199305203282003.
Interest in the antioxidant vitamin E as a possible protective nutrient against coronary disease has intensified with the recognition that oxidized low-density lipoprotein may be involved in atherogenesis.
In 1980, 87,245 female nurses 34 to 59 years of age who were free of diagnosed cardiovascular disease and cancer completed dietary questionnaires that assessed their consumption of a wide range of nutrients, including vitamin E. During follow-up of up to eight years (679,485 person-years) that was 97 percent complete, we documented 552 cases of major coronary disease (437 nonfatal myocardial infarctions and 115 deaths due to coronary disease).
As compared with women in the lowest fifth of the cohort with respect to vitamin E intake, those in the top fifth had a relative risk of major coronary disease of 0.66 (95 percent confidence interval, 0.50 to 0.87) after adjustment for age and smoking. Further adjustment for a variety of other coronary risk factors and nutrients, including other antioxidants, had little effect on the results. Most of the variability in intake and reduction in risk was attributable to vitamin E consumed as supplements. Women who took vitamin E supplements for short periods had little apparent benefit, but those who took them for more than two years had a relative risk of major coronary disease of 0.59 (95 percent confidence interval, 0.38 to 0.91) after adjustment for age, smoking status, risk factors for coronary disease, and use of other antioxidant nutrients (including multi-vitamins).
Although these prospective data do not prove a cause-and-effect relation, they suggest that among middle-aged women the use of vitamin E supplements is associated with a reduced risk of coronary heart disease. Randomized trials of vitamin E in the primary and secondary prevention of coronary disease are being conducted; public policy recommendations about the widespread use of vitamin E should await the results of these trials.
随着认识到氧化型低密度脂蛋白可能参与动脉粥样硬化的形成，人们对抗氧化维生素E作为一种可能预防冠心病的营养物质的兴趣日益浓厚。
1980年，87245名年龄在34至59岁之间、未被诊断患有心血管疾病和癌症的女性护士完成了饮食调查问卷，该问卷评估了她们对包括维生素E在内的多种营养物质的摄入量。在长达八年（679485人年）、完成率达97%的随访期间，我们记录了552例主要冠心病病例（437例非致命性心肌梗死和115例冠心病死亡）。
与队列中维生素E摄入量处于最低五分之一的女性相比，摄入量处于最高五分之一的女性在调整年龄和吸烟因素后，患主要冠心病的相对风险为0.66（95%可信区间为0.50至0.87）。进一步调整包括其他抗氧化剂在内的各种其他冠心病风险因素和营养物质后，结果影响不大。摄入量的大部分差异和风险降低归因于作为补充剂摄入的维生素E。短期服用维生素E补充剂的女性几乎没有明显益处，但在调整年龄、吸烟状况、冠心病风险因素和其他抗氧化营养物质（包括多种维生素）的使用情况后，服用超过两年的女性患主要冠心病的相对风险为0.59（95%可信区间为0.38至0.91）。
虽然这些前瞻性数据并未证明存在因果关系，但它们表明在中年女性中，服用维生素E补充剂与降低冠心病风险有关。目前正在进行维生素E在冠心病一级和二级预防中的随机试验；关于广泛使用维生素E的公共政策建议应等待这些试验的结果。
