BACKGROUND: The oxidative modification of low-density lipoproteins increases 
their incorporation into the arterial intima, an essential step in 
atherogenesis. Although dietary antioxidants, such as vitamin C, carotene, and 
vitamin E, have been hypothesized to prevent coronary heart disease, prospective 
epidemiologic data are sparse.
METHODS: In 1986, 39,910 U.S. male health professionals 40 to 75 years of age 
who were free of diagnosed coronary heart disease, diabetes, and 
hypercholesterolemia completed detailed dietary questionnaires that assessed 
their usual intake of vitamin C, carotene, and vitamin E in addition to other 
nutrients. During four years of follow-up, we documented 667 cases of coronary 
disease.
RESULTS: After controlling for age and several coronary risk factors, we 
observed a lower risk of coronary disease among men with higher intakes of 
vitamin E (P for trend = 0.003). For men consuming more than 60 IU per day of 
vitamin E, the multivariate relative risk was 0.64 (95 percent confidence 
interval, 0.49 to 0.83) as compared with those consuming less than 7.5 IU per 
day. As compared with men who did not take vitamin E supplements, men who took 
at least 100 IU per day for at least two years had a multivariate relative risk 
of coronary disease of 0.63 (95 percent confidence interval, 0.47 to 0.84). 
Carotene intake was not associated with a lower risk of coronary disease among 
those who had never smoked, but it was inversely associated with the risk among 
current smokers (relative risk, 0.30; 95 percent confidence interval, 0.11 to 
0.82) and former smokers (relative risk, 0.60; 95 percent confidence interval, 
0.38 to 0.94). In contrast, a high intake of vitamin C was not associated with a 
lower risk of coronary disease.
CONCLUSIONS: These data do not prove a causal relation, but they provide 
evidence of an association between a high intake of vitamin E and a lower risk 
of coronary heart disease in men. Public policy recommendations with regard to 
the use of vitamin E supplements should await the results of additional studies.