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Vitamin E Increases Risk of Hemorrhagic Stroke, Reduces Ischemic Stroke

Henry I. Bussey, Pharm.D.
December, 2010

A large meta analysis of 9 placebo controlled trials including approximately 119,000 patients found that vitamin E supplementation increases the risk of hemorrhagic stroke by 20% while reducing ischemic stroke by 10%. It was estimated that vitamin E supplementation would prevent one ischemic stroke per 476 treated patients while inducing one hemorrhagic stroke for every 1,250 patients. Overall, the total stroke risk was not different. Because of the fact that hemorrhagic strokes typically result in more severe outcomes, the authors advise against the use of vitamin E. It is important to note that the combination of vitamin E with anticoagulant and/or anti-platelet therapy was NOT examined in this trial so that one can not determine how combination therapy might affect the risk of ischemic or hemorrhagic stroke. The review also discusses the conflicting data as to whether vitamin E does or does not alter the risk of coronary artery disease. In general, data to support a reduction in coronary events comes from observational studies while the results from controlled trials fail to support such an effect. The mechanism behind an increased bleeding risk with vitamin E is not yet understood; although a possible anti-platelet effect or an inhibitory effect on the activation of certain clotting factors were mentioned as possible mechanisms.

Reference

Schurks M, Glynn RJ, Rist PM, Tzourio C, Kurth T. Effects of vitamin E on stroke subtypes: meta-analysis of randomized controlled trials. British Medical Journal 2010; 341:c5702 [or BMJ 2010; 341:c5702 doi: 10.1136/bmj.c5702]

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Saturday, December 16, 2017