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Effects of vitamin E on stroke: a systematic review with meta-analysis and trial sequential analysis
There are several previous studies on the association of vitamin E with prevention of stroke but the findings remain controversial. We have conducted a systematic review, meta-analysis together with trial sequential analysis of randomised controlled trials to evaluate the effect of vitamin E supplem...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8005911/ https://www.ncbi.nlm.nih.gov/pubmed/33109618 http://dx.doi.org/10.1136/svn-2020-000519 |
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author | Loh, Hong Chuan Lim, Renly Lee, Kai Wei Ooi, Chin Yik Chuan, Deik Roy Looi, Irene Kah Hay, Yuen Abdul Karim Khan, Nurzalina |
author_facet | Loh, Hong Chuan Lim, Renly Lee, Kai Wei Ooi, Chin Yik Chuan, Deik Roy Looi, Irene Kah Hay, Yuen Abdul Karim Khan, Nurzalina |
author_sort | Loh, Hong Chuan |
collection | PubMed |
description | There are several previous studies on the association of vitamin E with prevention of stroke but the findings remain controversial. We have conducted a systematic review, meta-analysis together with trial sequential analysis of randomised controlled trials to evaluate the effect of vitamin E supplementation versus placebo/no vitamin E on the risk reduction of total, fatal, non-fatal, haemorrhagic and ischaemic stroke. Relevant studies were identified by searching online databases through Medline, PubMed and Cochrane Central Register of Controlled Trials. A total of 18 studies with 148 016 participants were included in the analysis. There was no significant difference in the prevention of total stroke (RR (relative risk)=0.98, 95% CI 0.92–1.04, p=0.57), fatal stroke (RR=0.96, 95% CI 0.77–1.20, p=0.73) and non-fatal stroke (RR=0.96, 95% CI 0.88–1.05, p=0.35). Subgroup analyses were performed under each category (total stroke, fatal stroke and non-fatal stroke) and included the following subgroups (types of prevention, source and dosage of vitamin E and vitamin E alone vs control). The findings in all subgroup analyses were statistically insignificant. In stroke subtypes analysis, vitamin E showed significant risk reduction in ischaemic stroke (RR=0.92, 95% CI 0.85–0.99, p=0.04) but not in haemorrhagic stroke (RR=1.17, 95% CI 0.98–1.39, p=0.08). However, the trial sequential analysis demonstrated that more studies were needed to control random errors. Limitations of this study include the following: trials design may not have provided sufficient power to detect a change in stroke outcomes, participants may have had different lifestyles or health issues, there were a limited number of studies available for subgroup analysis, studies were mostly done in developed countries, and the total sample size for all included studies was insufficient to obtain a meaningful result from meta-analysis. In conclusion, there is still a lack of statistically significant evidence of the effects of vitamin E on the risk reduction of stroke. Nevertheless, vitamin E may offer some benefits in the prevention of ischaemic stroke and additional well-designed randomised controlled trials are needed to arrive at a definitive finding. PROSPERO registration number: CRD42020167827. |
format | Online Article Text |
id | pubmed-8005911 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-80059112021-04-13 Effects of vitamin E on stroke: a systematic review with meta-analysis and trial sequential analysis Loh, Hong Chuan Lim, Renly Lee, Kai Wei Ooi, Chin Yik Chuan, Deik Roy Looi, Irene Kah Hay, Yuen Abdul Karim Khan, Nurzalina Stroke Vasc Neurol Review There are several previous studies on the association of vitamin E with prevention of stroke but the findings remain controversial. We have conducted a systematic review, meta-analysis together with trial sequential analysis of randomised controlled trials to evaluate the effect of vitamin E supplementation versus placebo/no vitamin E on the risk reduction of total, fatal, non-fatal, haemorrhagic and ischaemic stroke. Relevant studies were identified by searching online databases through Medline, PubMed and Cochrane Central Register of Controlled Trials. A total of 18 studies with 148 016 participants were included in the analysis. There was no significant difference in the prevention of total stroke (RR (relative risk)=0.98, 95% CI 0.92–1.04, p=0.57), fatal stroke (RR=0.96, 95% CI 0.77–1.20, p=0.73) and non-fatal stroke (RR=0.96, 95% CI 0.88–1.05, p=0.35). Subgroup analyses were performed under each category (total stroke, fatal stroke and non-fatal stroke) and included the following subgroups (types of prevention, source and dosage of vitamin E and vitamin E alone vs control). The findings in all subgroup analyses were statistically insignificant. In stroke subtypes analysis, vitamin E showed significant risk reduction in ischaemic stroke (RR=0.92, 95% CI 0.85–0.99, p=0.04) but not in haemorrhagic stroke (RR=1.17, 95% CI 0.98–1.39, p=0.08). However, the trial sequential analysis demonstrated that more studies were needed to control random errors. Limitations of this study include the following: trials design may not have provided sufficient power to detect a change in stroke outcomes, participants may have had different lifestyles or health issues, there were a limited number of studies available for subgroup analysis, studies were mostly done in developed countries, and the total sample size for all included studies was insufficient to obtain a meaningful result from meta-analysis. In conclusion, there is still a lack of statistically significant evidence of the effects of vitamin E on the risk reduction of stroke. Nevertheless, vitamin E may offer some benefits in the prevention of ischaemic stroke and additional well-designed randomised controlled trials are needed to arrive at a definitive finding. PROSPERO registration number: CRD42020167827. BMJ Publishing Group 2020-10-27 /pmc/articles/PMC8005911/ /pubmed/33109618 http://dx.doi.org/10.1136/svn-2020-000519 Text en © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) . |
spellingShingle | Review Loh, Hong Chuan Lim, Renly Lee, Kai Wei Ooi, Chin Yik Chuan, Deik Roy Looi, Irene Kah Hay, Yuen Abdul Karim Khan, Nurzalina Effects of vitamin E on stroke: a systematic review with meta-analysis and trial sequential analysis |
title | Effects of vitamin E on stroke: a systematic review with meta-analysis and trial sequential analysis |
title_full | Effects of vitamin E on stroke: a systematic review with meta-analysis and trial sequential analysis |
title_fullStr | Effects of vitamin E on stroke: a systematic review with meta-analysis and trial sequential analysis |
title_full_unstemmed | Effects of vitamin E on stroke: a systematic review with meta-analysis and trial sequential analysis |
title_short | Effects of vitamin E on stroke: a systematic review with meta-analysis and trial sequential analysis |
title_sort | effects of vitamin e on stroke: a systematic review with meta-analysis and trial sequential analysis |
topic | Review |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8005911/ https://www.ncbi.nlm.nih.gov/pubmed/33109618 http://dx.doi.org/10.1136/svn-2020-000519 |
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