Alpha-tocopherol supplements: benefits and risks in adults
What it found
High-dose alpha-tocopherol supplements are linked to more deaths, heart failure, bleeding, and prostate cancer in some groups, while low doses may help.
The evidence comes from trials and meta-analyses in people, plus some animal and lab studies.
What they found
Studies in people
Death from any cause
A 2005 meta-analysis of 135,967 participants in 19 trials found that high-dose vitamin E (400 IU/day or more) was linked to a higher risk of death from any cause. The risk difference was 39 per 10,000 people. Doses above 150 IU/day were linked to increased risk.
Heart failure risk
In the HOPE and HOPE-TOO trials, vitamin E was an independent predictor of heart failure in people with vascular disease or diabetes. In the GISSI-Prevenzione trial, people who had a recent heart attack and had poor ventricular function had a 50% increased risk of heart failure.
Stroke risk
A 2010 meta-analysis of 118,765 people found that vitamin E increased the risk of hemorrhagic stroke by 22% and decreased the risk of ischemic stroke by 10%. The authors said the increase in hemorrhagic stroke outweighed the reduction in ischemic stroke.
Bleeding with blood thinners
In people taking warfarin, higher serum vitamin E levels were linked to more minor and major bleeding. Vitamin E also interferes with vitamin K-dependent clotting factors.
Animal and lab studies
Bone strength in rats
A Harvard study found that rats given mega-doses of vitamin E developed 20% weaker bones than rats on a normal diet. This effect has not been studied in humans.
Studies in people and animals
Prostate cancer risk
The SELECT trial, which followed 35,533 men, found a 17% increase in prostate cancer in men taking vitamin E alone compared to placebo. Lab studies with prostate cells suggest vitamin E may promote cell growth and survival.
What the authors conclude
“Overall, the findings in these studies strongly suggest that while low-dose Vitamin E supplementation may be beneficial, high-dose supplementation can pose serious risks to patients, especially those with a history of cardiovascular disease or stroke.”
Also in their conclusions
- They conclude that low-dose vitamin E supplementation may be beneficial, but high-dose supplementation can pose serious risks, especially for patients with a history of cardiovascular disease or stroke.
- They advise that vitamin E supplementation should be used cautiously in patients taking anticoagulant and antiplatelet drugs.
- They recommend that most people should get vitamin E from a balanced diet, and that supplementation should only be started under a doctor's guidance.
How it was done
The authors wanted to clarify the balance between the claimed benefits of vitamin E supplements and growing evidence of harm at high doses.
They reviewed large trials and meta-analyses of vitamin E supplementation in adults, including the HOPE, GISSI-Prevenzione, and SELECT trials, plus animal and lab studies on how harm might occur.
What it can’t tell you
- Most trials included older adults with existing health conditions, so the findings may not apply to healthy younger people.
- Animal and lab studies can suggest how harm might happen, but they cannot show what happens in people.
- The link between vitamin E and bleeding comes from studies that followed people over time, so they can show a link but not prove cause and effect.
Who paid
- Conflicts
- Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.
- Authors work at
- Louisiana State University Health Sciences Center, USA; University of the Pacific, USA
The paper
- Title
- Vitamin E (α-Tocopherol): Emerging Clinical Role and Adverse Risks of Supplementation in Adults
- Type
- ReviewThe authors read earlier studies and describe what they found. It isn’t a new study.
- Evidence
- Studies in people · animals · lab
- Summarised from
- Full text
- Cite
- Kaye AD, Thomassen AS, Mashaw SA, et al (2025). Vitamin E (α-Tocopherol): Emerging Clinical Role and Adverse Risks of Supplementation in Adults. Cureus. doi:10.7759/cureus.78679Free full textPubMed 40065887DOI
Summary written 26 Sep 2026. Check it against the paper before it changes what you eat. How we summarise papers · Report an error