Copyright © 2004 by the European Society of Cardiology.
Clinical research
Effect of 
-tocopherol and ß-carotene supplementation on coronary heart disease during the 6-year post-trial follow-up in the ATBC study
a National Public Health Institute, Department of Epidemiology and Health Promotion, Mannerheiminite 166, 00300 Helsinki, Finland
b National Cancer Institute, Bethesda, MD, USA
Received October 29, 2003;
revised May 3, 2004;
accepted May 5, 2004
* Corresponding author. Tel.: +358-9-4744-8481; fax: +358-9-4744-8591
E-mail address: markareetta.tornwall{at}ktl.fi
E-mail address: jarmo.virtamo{at}ktl.fi
Aims To evaluate the 6-year post-trial effects of 
-tocopherol and ß-carotene supplementation on coronary heart disease (CHD) in the -tocopherol, ß-carotene cancer prevention (ATBC) study.
Methods and results 29,133 male smokers, aged 50–69 years were randomised to receive -tocopherol 50 mg, or ß-carotene 20 mg, or both, or placebo daily for 5–8 years. At the beginning of the post-trial follow-up, 23,144 men were still at risk for a first-ever major coronary event (MCE), and 1255 men with pre-trial history of myocardial infarction (MI) were at risk for MCE. Post-trial risk for MCE (
) was 0.95 (95% confidence interval 0.87–1.04) among -tocopherol recipients compared with non-recipients, and 1.14 (1.04–1.24) among ß-carotene recipients compared with non-recipients. The risk for non-fatal MI (
) was 0.96 (0.85–1.09) and 1.16 (1.03–1.32), and for fatal CHD (
) 0.94 (0.83–1.06) and 1.11 (0.99–1.25), respectively. Among men with pre-trial MI no effects were observed in post-trial risk of MCE (
).
Conclusion ß-Carotene seemed to increase the post-trial risk of first-ever non-fatal MI but there is no plausible mechanism to support it. Our findings do not advocate the use of -tocopherol or ß-carotene supplements in prevention of CHD among male smokers.
Key Words: -Tocopherol • ß-Carotene • Supplementation • Coronary heart disease
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