Effect of α-tocopherol and β-carotene supplementation on coronary heart disease during the 6-year post-trial follow-up in the ATBC study

Aims To evaluate the 6-year post-trial effects of alpha-tocopherol and P-carotene supplementation on coronary heart disease (CHD) in the alpha-tocopherol, beta-carotene cancer prevention (ATBC) study. Methods and results 29 133 mate smokers, aged 50-69 years were randomised to receive alpha-tocopherol 50 mg, or beta-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 (n = 2059) was 0.95 (95% confidence interval 0.87-1.04) among alpha-tocopherol recipients compared with non-recipients, and 1.14 (1.04-1.24) among beta-carotene recipients compared with non-recipients. The risk for non-fatal MI (n = 993) was 0.96 (0.85-1.09) and 1.16 (1.03-1.32), and for fatal CHD (n = 1066) 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 (n = 257). Conclusion alphabeta-Carotene seemed to increase the post-trial. risk of first-ever non-fatal Ml but there is no plausible mechanism to support it. Our findings do not advocate the use of alpha-tocopherot or beta-carotene supplements in prevention of CHD among mate smokers. (C) 2004 The European Society of Cardiology. Published by Elsevier Ltd. All rights reserved.