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Director's Comments Transcript: Vitamins, Rheumatoid Arthritis & Heart Disease 12/30/2008

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Greetings from the National Library of Medicine and

Regards to all our listeners!

I'm Rob Logan, Ph.D. senior staff National Library of Medicine substituting this week for Donald Lindberg, M.D, the Director of the U.S. National of Medicine.

Here is what's new this week in MedlinePlus.

To listen to Dr. Lindberg's comments, click herelisten

The year's end resulted in two disappointing findings for those who hoped some common vitamins would help men prevent heart disease and women avert rheumatoid arthritis.

A recent study suggests women who take vitamin E do not reduce their risk of rheumatoid arthritis, or RA. Another study, released a few days before, found men do not reduce their risk of heart disease by taking vitamins E and C.

In the RA study, 39,144 adult women (who were at least 45 years old and did not have rheumatoid arthritis) were randomly assigned to a group that took vitamin E and to a group that took a placebo. The vitamin E- RA clinical trial was part of the Women's Health Study.

After about 10 years of follow ups, 50 women in the vitamin E group and 56 women who took the placebo developed RA. These differences were not statistically significant. In other words, vitamin E did not prevent RA in the largest clinical trial ever undertaken to measure its effectiveness.

The study's four authors, who are all affiliated with Harvard Medical School, acknowledged the study did not take into account the intake of vitamin E through food or other antioxidants. These may or may not have made a difference in the findings, which were published recently in Arthritis Care and Research.

The subjects in the Women's Health Study also were health professionals, who are better educated and have a higher income than the U.S. general population. Nevertheless, the authors note they doubt a women's educational level and income impact vitamin E's biological impact on RA.

The authors added fatty acids from oils, alcohol, coffee, red meat, and vitamin D consumption have been linked to the development of rheumatoid arthritis in women. However, they conclude the link between diet and the risk of RA remains unclear.

Incidentally, the Women's Health Study was conducted from 1992-2004 and involved 40,000 women health professionals from across the U.S. It was supported by the U.S. National Institutes of Health. The vitamin E - RA clinical trial represents one of an array of findings generated by the broader study.

In a separate clinical trial of health professionals, released in the Journal of the American Medical Association just before the RA research, vitamin E and vitamin C did not reduce the risk of heart disease in men.

This study divided 14,641 male physicians (age 50 or older who did not have heart disease) into four groups, who took either: both vitamins E and C, vitamin E and a placebo, vitamin C and a placebo, or two placebos. Similar to the RA research, the controls were blind, or no one knew the specific group assignments.

After eight years, there were no differences among the four groups in the incidence of heart attacks, stroke, congestive heart failure, or angina. In other words, vitamins E and C did not prevent heart disease in men within a large clinical trial to measure their effectiveness.

The Physicians Health Study was conducted from 1997-2007 and involved physicians screened in two phases from across the U.S. The results in this clinical trial represent one series of findings generated by a broader study.

An interesting sidebar to this study is the research was co-sponsored by the National Institutes of Health and the BASF Corporation, which makes vitamins (among many other products). As a result, the study's publication challenges the idea that industry-sponsored clinical trials sometimes fail to report unfavorable findings.

The vitamin E and C – heart disease trial's lead author (coincidentally at Brigham and Women's Hospital where the RA research was led) told the New York Times his group is currently testing if a standard multivitamin pill reduces the risk of heart disease.

We should add we devoted a podcast this fall to reporting that a clinical trial of vitamin E and selenium's impact on prostate cancer was canceled after early results suggested the treatment was doing more harm than good.

Overall, we do not wish to provide the impression that vitamins are not therapeutic. Let's remember the importance and challenge of clinical trials is to demonstrate clinical efficacy and results can be surprising.

As trials continue, there is comprehensive information about vitamin C, as well as some other vitamins sold over-the-counter, within the 'drugs and supplements' section that is accessible on's home page. also contains comprehensive information about heart disease and rheumatoid arthritis, which are easiest to access by looking at the heart diseases health topic page and the rheumatoid arthritis health topic page.

To find the rheumatoid arthritis health topic page, type 'RA' in the search box on's home page. Then, click on 'rheumatoid arthritis (National Library of Medicine).'

To find the heart disease health topic page, type 'heart disease' in the search box on's home page. Then, click on 'heart diseases (National Library of Medicine).'

There is a section on men and heart disease within's heart disease health topic page.

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