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Vitamin E is used in the treatment of known or suspected vitamin E deficiency. The use of vitamin E to prevent or treat a wide variety of diseases has been examined quite extensively and in some cases has been found to be of some benefit, although the effect is frequently minimal. Vitamin E may help in Alzheimer disease, dysmenorrhea, nonalcoholic fatty liver, and tardive dyskinesias, to name a few. However, in most cases, and especially for common diseases, there is often no proven benefit or the studies are contradictory.

Vitamin E has been extensively studied for the prevention of cardiovascular disease, but evidence against any benefit continues to accumulate.44,98 Indeed, some studies show that vitamin E supplementation may actually increase stroke risk98 or all cause mortality.55 It has also been suggested that megadoses of tocopherol be used in the treatment of peripheral vascular disease. Although some studies support this proposal, experts in the field state that further clinical studies are necessary to make a definitive recommendation. Nevertheless, it continues to be popular and controversial to consider the beneficial effects, and investigations of megavitamin E therapy for cardiovascular disease continue to appear in the literature.97

The failure to demonstrate the protective effects against heart diseases by vitamin E supplements may be because they contain only a-tocopherol. To effectively remove the

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