Various studies have evaluated the antioxidant effects of vitamin E in the 
prevention or treatment of coronary artery disease (CAD). In vitro data suggest 
that vitamin E protects against oxidation of low-density lipoprotein and 
decreases the deposition of atherogenic oxidized low-density lipoprotein in 
arterial walls. Various observational and epidemiological studies also suggest a 
relationship between vitamin E serum concentrations or intake and CAD. One 
prospective, randomized trial suggested that low-dosage vitamin E 
supplementation (50 IU/d) decreases the risk of angina in patients without 
previously diagnosed CAD. Another study, using high-dosage vitamin E 
supplementation (400 or 800 IU/d), demonstrated a decrease in the combined end 
point of nonfatal myocardial infarction and cardiovascular death in patients 
with established CAD. Discordant data, however, have been published that imply 
no cardiovascular benefit of low-dosage vitamin E supplementation (50 IU/d) and 
detrimental effects if vitamin E is combined with beta carotene. At this point, 
clinicians should emphasize a low-fat diet with high intake of fruits and 
vegetable sources containing vitamin E. Supplemental vitamin E may be considered 
in patients at high risk for CAD or with documented CAD, but the potential 
beneficial effects should be weighed against possible long-term adverse effects. 
If vitamin E supplementation is initiated, the literature suggests dosages of 
100 to 400 IU/d, with the higher dosage considered in patients with documented 
CAD. Additional investigation is warranted to further define the role of vitamin 
E supplementation in CAD and to critically evaluate the optimal dosage, duration 
of use, and method of consumption (dietary vs supplemental).