Skip to main content

Vitamin E for the Prevention and Treatment of Cardiovascular Disease

  • Chapter
  • First Online:
Lipophilic Vitamins in Health and Disease

Abstract

Cardiovascular disease (CVD) is a major health and economic concern worldwide. Vitamins are considered to be of great importance for maintaining cardiovascular function in health and disease. A deficiency of the antioxidant vitamin E has been linked to an increase in the risk of CVD and oxidative stress is one of the main factors in the pathogenesis of this disorder. However, despite several lines of experimental evidence, observational and interventional studies have yielded inconclusive and conflicting data. Accordingly, in this article, it is intended to discuss the controversies regarding the actions of vitamin E in cardiovascular health and disease, and describe the beneficial role of vitamin E in protection against cardiovascular complications in diabetes. It is suggested that the clinical efficacy of vitamin E in preventing the development of CVD may only be observed in specific patient populations.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Institutional subscriptions

References

  1. Shah AK, Dhalla NS (2021) Effectiveness of some vitamins in the prevention of cardiovascular disease: a narrative review. Front Physiol 12:729255

    Article  PubMed  PubMed Central  Google Scholar 

  2. Núñez-Córdoba JM, Martínez-González MA (2011) Antioxidant vitamins and cardiovascular disease. Curr Top Med Chem 11(14):1861–1869

    Article  PubMed  Google Scholar 

  3. Ziegler M, Wallert M, Lorkowski S, Peter K (2020) Cardiovascular and metabolic protection by vitamin E: a matter of treatment strategy? Antioxidants 9(10):935

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Singh U, Devaraj S (2007) Vitamin E: inflammation and atherosclerosis. Vitam Horm 76:519–549

    Article  CAS  PubMed  Google Scholar 

  5. Ciarcià G, Bianchi S, Tomasello B et al (2022) Vitamin E and non-communicable diseases: a review. Biomedicines 10(10):2473

    Article  PubMed  PubMed Central  Google Scholar 

  6. Pryor WA (2000) Vitamin E and heart disease: basic science to clinical intervention trials. Free Radic Biol Med 28(1):141–164

    Article  CAS  PubMed  Google Scholar 

  7. Clarke MW, Burnett JR, Croft KD (2008) Vitamin E in human health and disease. Crit Rev Clin Lab Sci 45(5):417–450

    Article  CAS  PubMed  Google Scholar 

  8. Violi F, Nocella C, Loffredo L et al (2022) Interventional study with vitamin E in cardiovascular disease and meta-analysis. Free Radic Biol Med 178:26–41

    Article  CAS  PubMed  Google Scholar 

  9. Niki E (2014) Role of vitamin E as a lipid-soluble peroxyl radical scavenger: in vitro and in vivo evidence. Free Radic Biol Med 66:3–12

    Article  CAS  PubMed  Google Scholar 

  10. Saito Y (2021) Diverse cytoprotective actions of vitamin E isoforms-role as peroxyl radical scavengers and complementary functions with selenoproteins. Free Radic Biol Med 175:121–129

    Article  CAS  PubMed  Google Scholar 

  11. Zhang PY, Xu X, Li XC (2014) Cardiovascular diseases: oxidative damage and antioxidant protection. Eur Rev Med Pharmacol Sci 18(20):3091–3096

    PubMed  Google Scholar 

  12. Suzuki A, Urano Y, Ishida T, Noguchi N (2021) Different functions of vitamin E homologues in the various types of cell death induced by oxysterols. Free Radic Biol Med 176:356–365

    Article  CAS  PubMed  Google Scholar 

  13. Sethi R, Takeda N, Nagano M, Dhalla NS (2000) Beneficial effects of vitamin E treatment in acute myocardial infarction. J Cardiovasc Pharmacol Ther 5(1):51–58

    Article  CAS  PubMed  Google Scholar 

  14. Tappia PS, Hata T, Hozaima L et al (2001) Role of oxidative stress in catecholamine-induced changes in cardiac sarcolemmal Ca2+ transport. Arch Biochem Biophys 387(1):85–92

    Article  CAS  PubMed  Google Scholar 

  15. Tappia PS, Dent MR, Dhalla NS (2006) Oxidative stress and redox regulation of phospholipase D in myocardial disease. Free Radic Biol Med 41(3):349–361

    Article  CAS  PubMed  Google Scholar 

  16. Xu YJ, Tappia PS, Neki NS, Dhalla NS (2014) Prevention of diabetes-induced cardiovascular complications upon treatment with antioxidants. Heart Fail Rev 19(1):113–121

    Article  CAS  PubMed  Google Scholar 

  17. Adameova A, Shah AK, Dhalla NS (2020) Role of oxidative stress in the genesis of ventricular arrhythmias. Int J Mol Sci 21(12):4200

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Dhalla NS, Shah AK, Tappia PS (2020) Role of oxidative stress in metabolic and subcellular abnormalities in diabetic cardiomyopathy. Int J Mol Sci 21(7):2413

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Barteková M, Adameová A, Görbe A et al (2021) Natural and synthetic antioxidants targeting cardiac oxidative stress and redox signaling in cardiometabolic diseases. Free Radic Biol Med 169:446–477

    Article  PubMed  Google Scholar 

  20. Dhalla NS, Elimban V, Bartekova M, Adameova A (2022) Involvement of oxidative stress in the development of subcellular defects and heart disease. Biomedicines 10(2):393

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Conrad M, Kagan VE, Bayir H et al (2018) Regulation of lipid peroxidation and ferroptosis in diverse species. Genes Dev 32(9–10):602–619

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Niki E (2015) Evidence for beneficial effects of vitamin E. Korean J Intern Med 30(5):571–579

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Rodrigo R, Prat H, Passalacqua W et al (2008) Decrease in oxidative stress through supplementation of vitamins C and E is associated with a reduction in blood pressure in patients with essential hypertension. Clin Sci 114(10):625–634

    Article  CAS  Google Scholar 

  24. Roberts JM, Myatt L, Spong CY et al (2010) Vitamins C and E to prevent complications of pregnancy-associated hypertension. N Engl J Med 362(14):1282–1291

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Salonen JT, Nyyssönen K, Salonen R et al (2000) Antioxidant supplementation in atherosclerosis prevention (ASAP) study: a randomized trial of the effect of vitamins E and C on 3-year progression of carotid atherosclerosis. J Intern Med 248(5):377–386

    Article  CAS  PubMed  Google Scholar 

  26. Antoniades C, Tousoulis D, Tentolouris C et al (2003) Oxidative stress, antioxidant vitamins, and atherosclerosis. From basic research to clinical practice. Herz 28(7):628–638

    Article  PubMed  Google Scholar 

  27. Rimm EB, Stampfer MJ, Ascherio A et al (1993) Vitamin E consumption and the risk of coronary heart disease in men. N Engl J Med 328(20):1450–1456

    Article  CAS  PubMed  Google Scholar 

  28. Contreras-Duarte S, Chen P, Andía M et al (2018) Attenuation of atherogenic apo-B-48-dependent hyperlipidemia and high density lipoprotein remodeling induced by vitamin C and E combination and their beneficial effect on lethal ischemic heart disease in mice. Biol Res 51(1):34–44

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Nagel E, Meyer zu Vilsendorf A, Bartels M, Pichlmayr R (1997) Antioxidative vitamins in prevention of ischemia/reperfusion injury. Int J Vitam Nutr Res 67(5):298–306

    CAS  PubMed  Google Scholar 

  30. Wallert M, Ziegler M, Wang X et al (2019) α-Tocopherol preserves cardiac function by reducing oxidative stress and inflammation in ischemia/reperfusion injury. Redox Biol 26:101292

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Zarkasi KA, Jen-Kit T, Jubri Z (2019) Molecular understanding of the cardiomodulation in myocardial infarction and the mechanism of vitamin E protections. Mini Rev Med Chem 19(17):1407–1426

    Article  CAS  PubMed  Google Scholar 

  32. Dhalla KS, Rupp H, Beamish RE, Dhalla NS (1996) Mechanisms of alterations in cardiac membrane Ca2+ transport due to excess catecholamines. Cardiovasc Drugs Ther 10:231–238

    Article  PubMed  Google Scholar 

  33. Sethi R, Adameova A, Dhalla KS et al (2009) Modification of epinephrine-induced arrhythmias by N-acetyl-L-cysteine and vitamin E. J Cardiovasc Pharmacol Ther 14(2):134–142

    Article  CAS  PubMed  Google Scholar 

  34. Sethi R, Rehsia NS, Jindal K et al (2009) Antiarrhythmic effects of some antioxidant vitamins in rats injected with epinephrine. Cardiovasc Toxicol 9(4):177–184

    Article  CAS  PubMed  Google Scholar 

  35. Ueda S, Yasunari K (2006) What we learnt from randomized clinical trials and cohort studies of antioxidant vitamin? Focus on vitamin E and cardiovascular disease. Curr Pharm Biotechnol 7(2):69–72

    Article  CAS  PubMed  Google Scholar 

  36. Cordero Z, Drogan D, Weikert C, Boeing H (2010) Vitamin E and risk of cardiovascular diseases: a review of epidemiologic and clinical trial studies. Crit Rev Food Sci Nutr 50(5):420–440

    Article  CAS  PubMed  Google Scholar 

  37. Debreceni B, Debreceni L (2012) Why do homocysteine-lowering B vitamin and antioxidant E vitamin supplementations appear to be ineffective in the prevention of cardiovascular diseases? Cardiovasc Ther 30(4):227–233

    Article  CAS  PubMed  Google Scholar 

  38. Goldenstein H, Levy NS, Lipener YT, Levy AP (2013) Patient selection and vitamin E treatment in diabetes mellitus. Expert Rev Cardiovasc Ther 11(3):319–326

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. Vardi M, Levy NS, Levy AP (2013) Vitamin E in the prevention of cardiovascular disease: the importance of proper patient selection. J Lipid Res 54(9):2307–2314

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Spencer AP, Carson DS, Crouch MA (1999) Vitamin E and coronary artery disease. Arch Intern Med 159:1313–1320

    Article  CAS  PubMed  Google Scholar 

  41. Singh U, Devaraj S, Jialal I (2005) Vitamin E, oxidative stress, and inflammation. Annu Rev Nutr 25:151–174

    Article  CAS  PubMed  Google Scholar 

  42. Wang T, Xu L (2019) Circulating Vitamin E levels and risk of coronary artery disease and myocardial infarction: a Mendelian randomization study. Nutrients 11:2153

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  43. Machado AD, Andrade GRG, Levy J et al (2019) Association between vitamins and minerals with antioxidant effects and coronary artery calcification in adults and older adults: a systematic review. Curr Pharm Des 25:2474–2479

    Article  CAS  PubMed  Google Scholar 

  44. Kushi LH, Folsom AR, Prineas RJ et al (1996) Dietary antioxidant vitamins and death from coronary heart disease in postmenopausal women. N Engl J Med 334:1156–1162

    Article  CAS  PubMed  Google Scholar 

  45. Saremi A, Arora R (2010) Vitamin E and Cardiovascular disease. Am J Ther 17:e56-65

    Article  PubMed  Google Scholar 

  46. Yusuf S, Dagenais G, Pogue J et al (2000) Vitamin E supplementation and cardiovascular events in high-risk patients. N Engl J Med 342:154–160

    Article  CAS  PubMed  Google Scholar 

  47. Pruthi S, Allison TG, Hensrud DD (2001) Vitamin E supplementation in the prevention of coronary heart disease. Mayo Clin Proc 76:1131–1136

    Article  CAS  PubMed  Google Scholar 

  48. Lee IM, Cook NR, Gaziano JM et al (2005) Vitamin E in the primary prevention of cardiovascular disease and cancer: the Women’s Health Study: a randomized controlled trial. JAMA 294(1):56–65

    Article  CAS  PubMed  Google Scholar 

  49. Mangione CM, Barry MJ, Nicholson WK et al (2022) Vitamin, mineral, and multivitamin supplementation to prevent cardiovascular disease and cancer: US preventive services task force recommendation statement. JAMA 327(23):2326–2333

    Article  PubMed  Google Scholar 

  50. O’Connor EA, Evans CV, Ivlev I et al (2022) Vitamin and mineral supplements for the primary prevention of cardiovascular disease and cancer: updated evidence report and systematic review for the US preventive services task force. JAMA 327(23):2334–2347

    Article  PubMed  Google Scholar 

  51. An P, Wan S, Luo Y et al (2022) Micronutrient supplementation to reduce cardiovascular risk. J Am Coll Cardiol 80(24):2269–2285

    Article  CAS  PubMed  Google Scholar 

  52. Dietrich M, Jacques PF, Pencina MJ et al (2009) Vitamin E supplement use and the incidence of cardiovascular disease and all-cause mortality in the Framingham Heart Study: does the underlying health status play a role? Atherosclerosis 205(2):549–553

    Article  CAS  PubMed  Google Scholar 

  53. Lonn E, Bosch J, Yusuf S et al (2005) Effects of long-term vitamin E supplementation on cardiovascular events and cancer: a randomized controlled trial. JAMA 293(11):1338–1347

    Article  PubMed  Google Scholar 

  54. Shekelle PG, Morton SC, Jungvig LK et al (2004) Effect of supplemental vitamin E for the prevention and treatment of cardiovascular disease. J Gen Intern Med 19(4):380–389

    Article  PubMed  PubMed Central  Google Scholar 

  55. de Freitas LBR, Longo L, Filippi-Chiela E et al (2022) Ornithine aspartate and vitamin-E combination has beneficial effects on cardiovascular risk factors in an animal model of nonalcoholic fatty liver disease in rats. Biomolecules 12(12):1773

    Article  PubMed  PubMed Central  Google Scholar 

  56. Manca-di-Villahermosa S, Giacominelli-Stuffler R, Angelucci CB et al (2011) Vitamin E-related inhibition of monocyte 5-lipoxygenase and cardiovascular outcome in maintenance hemodialysis patients. Recent Pat Inflamm Allergy Drug Discov 5(3):229–240

    Article  CAS  PubMed  Google Scholar 

  57. Siti HN, Kamisah Y, Kamsiah J (2015) The role of oxidative stress, antioxidants and vascular inflammation in cardiovascular disease (a review). Vascul Pharmacol 71:40–56

    Article  CAS  PubMed  Google Scholar 

  58. Mathur P, Ding Z, Saldeen T, Mehta JL (2015) Tocopherols in the prevention and treatment of atherosclerosis and related cardiovascular disease. Clin Cardiol 38(9):570–576

    Article  PubMed  PubMed Central  Google Scholar 

  59. Do M, Sn Kim, Seo SY et al (2015) δ-Tocopherol prevents methylglyoxal-induced apoptosis by reducing ROS generation and inhibiting apoptotic signaling cascades in human umbilical vein endothelial cells. Food Funct 6(5):1568–1577

    Article  CAS  PubMed  Google Scholar 

  60. Naidoo N, van Dam RM, Koh WP et al (2012) Plasma vitamin E and coenzyme Q10 are not associated with a lower risk of acute myocardial infarction in Singapore Chinese adults. J Nutr 142(6):1046–1052

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  61. Zainal Z, Khaza’ai H, Kutty Radhakrishnan A, Chang SK (2022) Therapeutic potential of palm oil vitamin E-derived tocotrienols in inflammation and chronic diseases: evidence from preclinical and clinical studies. Food Res Int 156:111175

    Article  CAS  PubMed  Google Scholar 

  62. Nakatomi T, Itaya-Takahashi M, Horikoshi Y et al (2023) The difference in the cellular uptake of tocopherol and tocotrienol is influenced by their affinities to albumin. Sci Rep 13(1):7392

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  63. Vasanthi HR, Parameswari RP, Das DK (2012) Multifaceted role of tocotrienols in cardioprotection supports their structure: function relation. Genes Nutr 7(1):19–28

    Article  CAS  PubMed  Google Scholar 

  64. Ramanathan N, Tan E, Loh LJ et al (2018) Tocotrienol is a cardioprotective agent against ageing-associated cardiovascular disease and its associated morbidities. Nutr Metab 15:6

    Article  Google Scholar 

  65. Kanchi MM, Shanmugam MK, Rane G et al (2017) Tocotrienols: the unsaturated sidekick shifting new paradigms in vitamin E therapeutics. Drug Discov Today 22(12):1765–1781

    Article  CAS  PubMed  Google Scholar 

  66. Stonehouse W, Brinkworth GD, Thompson CH, Abeywardena MY (2016) Short term effects of palm-tocotrienol and palm-carotenes on vascular function and cardiovascular disease risk: a randomised controlled trial. Atherosclerosis 254:205–214

    Article  CAS  PubMed  Google Scholar 

  67. Turan B, Vassort G (2011) Vitamin E in oxidant stress-related cardiovascular pathologies: focus on experimental studies. Curr Pharm Des 17(21):2155–2169

    Article  CAS  PubMed  Google Scholar 

  68. Gutteridge JM (1987) The antioxidant activity of haptoglobin towards haemoglobin-stimulated lipid peroxidation. Biochim Biophys Acta 917:219–223

    Article  CAS  PubMed  Google Scholar 

  69. Levy AP, Asleh R, Blum S et al (2010) Haptoglobin: basic and clinical aspects. Antioxid Redox Signal 12:293–304

    Article  CAS  PubMed  Google Scholar 

  70. Blum S, Vardi M, Brown JB et al (2010) Vitamin E reduces cardiovascular disease in individuals with diabetes mellitus and the haptoglobin 2–2 genotype. Pharmacogenomics 11(5):675–684

    Article  CAS  PubMed  Google Scholar 

  71. Cahill LE, Levy AP, Chiuve SE et al (2013) Haptoglobin genotype is a consistent marker of coronary heart disease risk among individuals with elevated glycosylated hemoglobin. J Am Coll Cardiol 61(7):728–737

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  72. Alshiek JA, Dayan L, Asleh R et al (2017) Anti-oxidative treatment with vitamin E improves peripheral vascular function in patients with diabetes mellitus and haptoglobin 2–2 genotype: a double-blinded cross-over study. Diabetes Res Clin Pract 131:200–207

    Google Scholar 

  73. Somer S, Levy AP (2020) The role of haptoglobin polymorphism in cardiovascular disease in the setting of diabetes. Int J Mol Sci 22(1):287

    Google Scholar 

  74. Hochberg I, Berinstein EM, Milman U et al (2017) Interaction between the haptoglobin genotype and vitamin E on cardiovascular disease in diabetes. Curr Diab Rep 17(6):42

    Article  PubMed  Google Scholar 

  75. Dalan R, Goh LL, Lim CJ et al (2020) Impact of vitamin E supplementation on vascular function in haptoglobin genotype stratified diabetes patients (EVAS Trial): a randomised controlled trial. Nutr Diabetes 10(1):13

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  76. Reno-Bernstein CM, Oxspring M, Bayles J et al (2022) Vitamin E treatment in insulin-deficient diabetic rats reduces cardiac arrhythmias and mortality during severe hypoglycemia. Am J Physiol Endocrinol Metab 323(5):E428–E434

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

We thank the St. Boniface Hospital Albrechtsen Research Centre for providing the infrastructural support for this project.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Paramjit S. Tappia .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2024 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Fitzpatrick-Wong, S.C., Tappia, P.S., Dhalla, N.S. (2024). Vitamin E for the Prevention and Treatment of Cardiovascular Disease. In: Tappia, P.S., Shah, A.K., Dhalla, N.S. (eds) Lipophilic Vitamins in Health and Disease. Advances in Biochemistry in Health and Disease, vol 28. Springer, Cham. https://doi.org/10.1007/978-3-031-55489-6_11

Download citation

Publish with us

Policies and ethics