The Pharmaceutical Journal
Vol 270 No 7253 p814
14 June 2003

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The Lancet (www.thelancet.com)

Use of vitamin A and beta carotene supplements should be discouraged

The use of vitamin supplements containing beta carotene and vitamin A should be "actively discouraged", say American researchers in this week's issue of The Lancet (2003;361:2017). Furthermore, the researchers do not support the routine use of vitamin E supplements to treat patients at high risk of coronary artery disease.

The warnings follow a meta-analysis of randomised trials in which they found that antioxidant vitamins are not effective in reducing the risk of cardiovascular disease. Supplements containing vitamin A compounds could actually contribute to an increase in cardiovascular death and all-cause mortality, they say.

Dr Marc Penn from the Cleveland Clinic Foundation, Ohio, and colleagues analysed seven randomised trials of treatment with vitamin E and eight trials of treatment with beta carotene, each involving more than 1,000 participants. Follow-up ranged from one to 12 years.

Compared with control treatment, vitamin E did not provide benefit in mortality (11.3 per cent versus 11.1 per cent, P=0.42) or significantly reduce the risk of cardiovascular death (6.0 per cent versus 6.0 per cent, P=0.86). Beta carotene was associated with a small increase in all-cause mortality (7.4 per cent versus 7.0 per cent, P=0.003) and with a slight increase in cardiovascular death (3.4 per cent versus 3.1 per cent, P=0.003).

Dr Penn said: "The use of vitamin supplements containing beta carotene and vitamin A, beta carotene's biologically active metabolite, should be actively discouraged because this family of agents is associated with a small but significant excess of all-cause mortality and cardiovascular death. We recommend that clinical studies of beta carotene should be discontinued because of its risks.

"Furthermore, given our results and the lack of mechanistic data supporting efficacy of vitamin E as a potent antioxidant in vivo, we do not support the continued use of vitamin E treatment and discourage the inclusion of vitamin E in future primary and secondary prevention trials in patients at high risk of coronary artery disease."