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In a recent editorial regarding the use of vitamin E for age-related macular degeneration, Chew and Clemons stated:
For these reasons, combined with little evidence from the meta-analysis of harm at the 400 IU/d dosage, we do not think there is increased risk of mortality associated with the AREDS [Age-Related Eye Disease Study] supplements that include 400 IU/d of vitamin E.1
Further, last year I questioned the use of high doses of vitamins E and C because of a study that showed that high doses were associated with heart disease in women.2 The response from Ferris and Milton3 was that the doses were higher than those used in the AREDS. Ferris and Milton also stated:
We know of no clear indication of increased risk of cardiovascular disease with the doses of vitamins C or E used in AREDS or in patients similar to the AREDS population.3
I wonder whether Chew and Clemons as well as Ferris and Milton could comment on recent data from the Heart Outcomes Prevention Evaluation–The Ongoing Outcomes study4 that should give all of us who prescribe 400 IU/d of vitamin E (the amount used in the AREDS) pause. This study showed that there was a 13% increase in heart failure and more than a 21% increase in hospitalization for heart failure in those who receive vitamin E and have a history of diabetes mellitus or vascular disease. The AREDS data published thus far show no difference in mortality with the use of vitamin E, but the AREDS investigators have not described whether there was a difference in cardiac morbidity with the use of vitamin E at 400 IU/d. The difference in heart failure morbidity in the Heart Outcomes Prevention Evaluation–The Ongoing Outcomes study was especially seen after 7 years. As many of our patients with age-related macular degeneration also have diabetes or vascular disease, can we be sure that we are not causing our patients to have severe cardiac morbidity at this doseage and that we are keeping to the concept of primum non nocere?
Correspondence: Dr Pulido, Mayo Clinic, 200 First St SW, Rochester, MN 55905-0001 (pulido.jose@mayo.edu).
Financial Disclosure: None reported.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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