Vitamin E supplementation (alone or with other antioxidants) and stroke: a meta-analysis

Enrico Maggio; Valeria Proietti Bocchini; Roberto Carnevale; Pasquale Pignatelli; Francesco Violi; Lorenzo Loffredo

doi:10.1093/nutrit/nuad114

Vitamin E supplementation (alone or with other antioxidants) and stroke: a meta-analysis

Nutr Rev. 2023 Sep 12:nuad114. doi: 10.1093/nutrit/nuad114. Online ahead of print.

Authors

Enrico Maggio¹, Valeria Proietti Bocchini¹, Roberto Carnevale^{2

3}, Pasquale Pignatelli¹, Francesco Violi³, Lorenzo Loffredo¹

Affiliations

¹ Department of Clinical Internal, Anesthesiological, and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy.
² Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy.
³ IRCCS Neuromed, Località Camerelle, Pozzilli (IS), Italy.

PMID: 37698992
DOI: 10.1093/nutrit/nuad114

Abstract

Context: A previous study showed that vitamin E is effective in reducing the incidence of myocardial infarction only when it is taken in the absence of other antioxidants. It is unclear if it also reduces the incidence of stroke.

Objective: The aim of this meta-analysis is to compare the effect of vitamin E supplementation alone or combined with other antioxidants on the incidence of stroke.

Data sources: A search was performed in the following databases: PubMed, ISI Web of Science, SCOPUS, and Cochrane Library.

Data extraction: Sixteen randomized controlled trials were selected to evaluate the effect of vitamin E supplementation on stroke.

Data analysis: The range of vitamin E doses used was 33-800 IU. The follow-up period ranged from 6 months to 9.4 years. Compared with controls, when vitamin E was given alone it did not reduce the incidence of ischemic and hemorrhagic stroke. Conversely, compared with controls, supplementation of vitamin E with other antioxidants reduced ischemic stroke (random effects, RR: 0.91; 95% CI: 0.84-0.99; P = 0.02) but with a significant increase in hemorrhagic stroke (random effects, RR: 1.22; 95% CI: 1.0-1.48; P = 0.04).

Conclusions: Supplementation with vitamin E alone is not associated with stroke reduction. Instead, supplementation of vitamin E with other antioxidants reduces the incidence of ischemic stroke but increases the risk of hemorrhagic stroke, cancelling any beneficial effect derived. Thus, vitamin E is not recommended in stroke prevention.

Systematic review registration: PROSPERO registration no. CRD42022258259.

Keywords: atherosclerosis; cardiovascular events; hemorrhagic stroke; ischemic stroke; stroke; vitamin E.