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Vitamin E Reduces Cardiovascular Disease in Individuals with Diabetes

The study shows that individuals with both diabetes and the Haptoglobin (Hp) 2-2 genotype can benefit from using Vitamin E, increasing life expectancy by 3 years….

Individuals with both diabetes mellitus (DM) and the Haptoglobin (Hp) 2-2 genotype are at increased risk of cardiovascular disease. As the antioxidant function of the Hp 2-2 protein is impaired, the study sought to test the pharmacogenomic hypothesis that antioxidant vitamin E supplementation would provide cardiovascular protection to Hp 2-2 DM individuals.

Researchers determined the Hp genotype on DM participants from two trials (HOPE and ICARE) and assessed the effect of vitamin E by Hp genotype on their common prespecified outcome, the composite of stroke, myocardial infarction and cardiovascular death. Data was analyzed with a fixed-effect model. These results were input into a simulation model, the Evidence Based Medicine Integrator, in order to estimate their long-term implications in a real-world population from Kaiser Permanente (CA, USA).

From the results it showed that meta-analysis of the two trials demonstrated a significant overall reduction in the composite end point in Hp 2-2 DM individuals with vitamin E (odds ratio: 0.58; 95% CI: 0.40–0.86; p = 0.006). There was a statistically significant interaction between the Hp genotype and vitamin E on the composite end point. In these trials, Hp typing of 69 DM individuals and treating those with the Hp 2-2 with vitamin E prevented one myocardial infarct, stroke or cardiovascular death. Lifelong administration of vitamin E to Hp 2-2 DM individuals in the Kaiser population would increase their life expectancy by 3 years.

In conclusion, Hp typing represents a once in a lifetime test that identifies those DM individuals at exceptionally high risk of CVD. The Hp type may be used to more effectively focus the attention of the clinician and the utilization of healthcare resources on those DM individuals for whom more aggressive risk factor modification is most needed. The Hp genotype also appears to identify a very large subgroup of DM individuals who may receive marked clinical benefit from an extremely inexpensive therapy. We hope that the public health implications of this study will be recognized to be of sufficient importance to warrant a large prospective clinical trial that could constitute the basis for conclusive treatment guidelines.

Pharmacogenomics. 2010;11(5):675-684