Vitamin E consists of a number of compounds, tocopherols and tocotrienols, that 
function as lipid-soluble antioxidants. A hypothesis is that vitamin E may slow 
the progression of atherosclerosis by blocking the oxidative modification of 
low-density lipoprotein cholesterol and thus decrease its uptake into the 
arterial lumen. Basic science and animal studies have generally supported this 
hypothesis. Observational studies have primarily assessed patients with no 
established coronary heart disease (CHD), and results have generally supported a 
protective role of vitamin E in CHD. Early primary and secondary prevention 
clinical trials (Alpha-Tocopherol, Beta-Carotene Cancer Protection study and 
Cambridge Heart Antioxidant Study) showed mixed results. Despite years of 
encouraging evidence from basic science and observational studies, 3 large 
randomized clinical trials (Gruppo Italiano per lo Studio della Sopravvivenza 
nell'Infarto miocardico, Heart Outcomes Prevention Evaluation, and Primary 
Prevention Project) with a combined total of more than 25,000 patients failed to 
show a significant benefit with vitamin E taken as a dietary supplement for the 
prevention of CHD. Four large randomized primary prevention trials currently 
under way should add to our knowledge. The American Heart Association has 
recommended consumption of a balanced diet with emphasis on antioxidant-rich 
fruits and vegetables but has made no recommendations regarding vitamin E 
supplementation for the general population. Although vitamin E supplementation 
seems to be safe for most people, recommendations from health care professionals 
should reflect the uncertainty of established benefit as demonstrated in 
clinical trials.