Effect of vitamin E on endothelial vasodilator function in patients with hypercholesterolemia, chronic smoking or both

J Am Coll Cardiol. 1999 Feb;33(2):499-505. doi: 10.1016/s0735-1097(98)00584-1.


Objectives: The purpose of this study was to test the hypothesis that long-term supplementation with Vitamin E improves endothelium-dependent relaxation in hypercholesterolemia patients and/or chronic smoking, two risk factors that have been shown to be associated with increased radical formation.

Background: Experimental evidence suggests that oxidized low density lipoprotein (LDL) impairs endothelium-dependent relaxation, and vitamin E, a lipid-soluble antioxidant, reduces the oxidation of LDL.

Methods: Thirteen subjects with hypercholesterolemia, 14 smokers and 15 hypercholesterolemic smokers were enrolled in a double-blind, placebo-controlled study. After baseline measurements of plasma autoantibodies against oxidized LDL and assessment of endothelium-dependent relaxation using intra-arterial forearm infusions of acetylcholine, participants within each group were randomly assigned in a 1:2 fashion to receive either placebo or vitamin E for 4 months, when plasma levels of autoantibodies against oxidized LDL and vascular function were reassessed.

Results: Vitamin E significantly augmented endothelium-dependent relaxation in hypercholesterolemic smokers but not in patients with either hypercholesterolemia or chronic smoking. At baseline, hypercholesterolemic smokers had significantly higher autoantibody levels against oxidized LDL (compared with the other two groups), which were significantly reduced after 4 months of vitamin E supplementation. There was a significant relationship between improvement in acetylcholine-induced vasodilation and the change in autoantibody titer against oxidized LDL (r = -0.59; p = 0.002).

Conclusions: Long-term vitamin E supplementation improves endothelium-dependent relaxation in forearm resistance vessels of hypercholesterolemic smokers, which are characterized by increased levels of autoantibodies against oxidized LDL. These findings may suggest that the beneficial effect of vitamin E is confined to subjects with increased exposure to oxidized LDL.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Acetylcholine / administration & dosage
  • Autoantibodies / analysis
  • Blood Flow Velocity
  • Brachial Artery / physiopathology
  • Cholesterol, LDL / immunology
  • Chronic Disease
  • Double-Blind Method
  • Endothelium, Vascular / drug effects*
  • Female
  • Follow-Up Studies
  • Humans
  • Hypercholesterolemia / blood
  • Hypercholesterolemia / physiopathology*
  • Immunoglobulin G / analysis
  • Injections, Intra-Arterial
  • Lipid Peroxidation / drug effects
  • Lipid Peroxides / antagonists & inhibitors
  • Lipid Peroxides / blood
  • Lipid Peroxides / immunology
  • Male
  • Middle Aged
  • Nitroprusside / administration & dosage
  • Prospective Studies
  • Smoking / blood
  • Smoking / physiopathology*
  • Vasodilation / physiology*
  • Vasodilator Agents / administration & dosage
  • Vitamin E / therapeutic use*


  • Autoantibodies
  • Cholesterol, LDL
  • Immunoglobulin G
  • Lipid Peroxides
  • Vasodilator Agents
  • Vitamin E
  • Nitroprusside
  • Acetylcholine