BACKGROUND: Interest in the antioxidant vitamin E as a possible protective 
nutrient against coronary disease has intensified with the recognition that 
oxidized low-density lipoprotein may be involved in atherogenesis.
METHODS: In 1980, 87,245 female nurses 34 to 59 years of age who were free of 
diagnosed cardiovascular disease and cancer completed dietary questionnaires 
that assessed their consumption of a wide range of nutrients, including vitamin 
E. During follow-up of up to eight years (679,485 person-years) that was 97 
percent complete, we documented 552 cases of major coronary disease (437 
nonfatal myocardial infarctions and 115 deaths due to coronary disease).
RESULTS: As compared with women in the lowest fifth of the cohort with respect 
to vitamin E intake, those in the top fifth had a relative risk of major 
coronary disease of 0.66 (95 percent confidence interval, 0.50 to 0.87) after 
adjustment for age and smoking. Further adjustment for a variety of other 
coronary risk factors and nutrients, including other antioxidants, had little 
effect on the results. Most of the variability in intake and reduction in risk 
was attributable to vitamin E consumed as supplements. Women who took vitamin E 
supplements for short periods had little apparent benefit, but those who took 
them for more than two years had a relative risk of major coronary disease of 
0.59 (95 percent confidence interval, 0.38 to 0.91) after adjustment for age, 
smoking status, risk factors for coronary disease, and use of other antioxidant 
nutrients (including multi-vitamins).
CONCLUSIONS: Although these prospective data do not prove a cause-and-effect 
relation, they suggest that among middle-aged women the use of vitamin E 
supplements is associated with a reduced risk of coronary heart disease. 
Randomized trials of vitamin E in the primary and secondary prevention of 
coronary disease are being conducted; public policy recommendations about the 
widespread use of vitamin E should await the results of these trials.