Prepared by:
Southern California-RAND Evidence-based Practice Center
Santa Monica, CA
Program Directors
Paul Shekelle, M.D., Ph.D.
Sally C. Morton, Ph.D.
Project Directors
Mary Hardy, M.D.
Ian Coulter, Ph.D.
Physician Reviewers
Jay Udani, M.D.
Myles Spar, M.P.H., M.D.
Karen Oda, M.D.
Programmer/Analyst
Lara K. Jungvig, B.A.
Statisticians
Wenli Tu, M.S.
Marika J. Suttorp, MS
Staff Assistants
Di Valentine, J.D.
Louis Ramirez, B.A.
Reference Librarian
Roberta Shanman, M.L.S.
Editor
Sydne J. Newberry, Ph.D.
File Name Description Software Version File Size ________________________________________________________________________________________________ 01front.doc Microsoft Word® Document MS Word® 2002 56KB 6 pages Contents: Title Page, Preface, Structured Abstract ________________________________________________________________________________________________ 02conts.doc Microsoft Word® Document MS Word® 2002 36KB 4 pages Contents: Table of Contents ________________________________________________________________________________________________ 03summ.doc Microsoft Word® Document MS Word® 2002 35KB 4 pages Contents: Summary: Overview, Methodology, Findings, Future Research ________________________________________________________________________________________________ 04chap1.doc Microsoft Word® Document MS Word® 2002 128KB 11 pages Contents: Chapter 1. Introduction: Purpose, Specific Aims, Cardiovascular Disease, Antioxidants and Cardiovascular Disease ________________________________________________________________________________________________ 05fig1.doc Microsoft Word® Document MS Word® 2002 56KB 1 page Contents: Figure 1. Vitamin C ________________________________________________________________________________________________ 06fig2.doc Microsoft Word® Document MS Word® 2002 407KB 1 page Contents: Figure 2. Vitamin E ________________________________________________________________________________________________ 07fig3.doc Microsoft Word® Document MS Word® 2002 77KB 1 page Contents: Figure 3. Coenzyme Q10 ________________________________________________________________________________________________ 08chap2.doc Microsoft Word® Document MS Word® 2002 51KB 7 pages Contents: Chapter 2. Methodology: Scope of Work, Objective, Literature Search Design, Evaluation of Evidence ________________________________________________________________________________________________ 09tbl1.doc Microsoft Word® Document MS Word® 2002 34KB 1 page Contents: Table 1. Biomedical and Other Databases Searched ________________________________________________________________________________________________ 10tbl2.doc Microsoft Word® Document MS Word® 2002 29KB 1 page Contents: Table 2. Additional Search Terms for Antioxidants Studied ________________________________________________________________________________________________ 11tbl3.doc Microsoft Word® Document MS Word® 2002 31KB 1 page Contents: Table 3. Summary of Search Strategy ________________________________________________________________________________________________ 12fig4.doc Microsoft Word® Document MS Word® 2002 33KB 1 page Contents: Figure 5. Vitamin E Alone vs. Placebo: All-cause Mortality ________________________________________________________________________________________________ 13tbl4.doc Microsoft Word® Document MS Word® 2002 50KB 1 page Contents: Table 4. Outcomes Reported for Vitamin C Studies (n=37) ________________________________________________________________________________________________ 14tbl5.doc Microsoft Word® Document MS Word® 2002 58KB 1 page Contents: Table 5. Outcomes Reported for Coenzyme Q10 Studies (n=54) ________________________________________________________________________________________________ 15chap3.doc Microsoft Word® Document MS Word® 2002 234KB 21 pages Contents: Chapter 3. Results: Description of the Evidence, Details of the "Named" Clinical Trials Included in Analysis, Vitamin E Trials That Report Death as an Outcome, Vitamin E Trials That Report on Myocardial Infarction as an Outcome, Vitamin E Trials That Reported on Lipids as an Outcome, Trials that Report on the Effect of Coenzyme Q10 Supplementation on Cardiovascular Disease Outcomes, Trials that Report on the Effect of Vitamin C Supplementation on Cardiovascular Disease Outcomes ________________________________________________________________________________________________ 16tbl6.doc Microsoft Word® Document MS Word® 2002 336KB 6 pages Contents: Table 6. Primary, secondary, and treatment trials ________________________________________________________________________________________________ 17tbl7.doc Microsoft Word® Document MS Word® 2002 66KB 1 page Contents: Table 7. Risk Ratios for Vitamin E Alone vs. Placebo: All-Cause Mortality ________________________________________________________________________________________________ 18fig5.doc Microsoft Word® Document MS Word® 2002 43KB 1 page Contents: Figure 5. Vitamin E Alone vs. Placebo: All-cause Mortality ________________________________________________________________________________________________ 19tbl8.doc Microsoft Word® Document MS Word® 2002 35KB 1 page Contents: Table 8. Publication Bias Test Results ________________________________________________________________________________________________ 20fig6.doc Microsoft Word® Document MS Word® 2002 36KB 1 page Contents: Figure 6. Vitamin E in Combination vs. Placebo: All-cause Mortality ________________________________________________________________________________________________ 21tbl9.doc Microsoft Word® Document MS Word® 2002 49KB 1 page Contents: Table 9. Risk Ratios for Vitamin E in Combination vs. Placebo: All-Cause Mortality ________________________________________________________________________________________________ 22tbl10.doc Microsoft Word® Document MS Word® 2002 42KB 1 page Contents: Table 10. Risk Ratios for Vitamin E Alone vs. Placebo: Cardiovascular Deaths ________________________________________________________________________________________________ 23fig7.doc Microsoft Word® Document MS Word® 2002 42KB 1 page Contents: Figure 7. Vitamin E Alone vs. Placebo: Cardiovascular deaths ________________________________________________________________________________________________ 24fig8.doc Microsoft Word® Document MS Word® 2002 36KB 1 page Contents: Figure 8. Publication Bias - Vitamin E Alone vs. Placebo: Cardiovascular deaths ________________________________________________________________________________________________ 25tbl11.doc Microsoft Word® Document MS Word® 2002 58KB 1 page Contents: Table 11. Risk Ratios for Vitamin E in Combination vs. Placebo: Cardiovascular Deaths ________________________________________________________________________________________________ 26fig9.doc Microsoft Word® Document MS Word® 2002 41KB 1 page Contents: Figure 9. Vitamin E in Combination vs. Placebo: Cardiovascular deaths ________________________________________________________________________________________________ 27fig10.doc Microsoft Word® Document MS Word® 2002 36KB 1 page Contents: Figure 10. Publication Bias - Vitamin E in Combination vs. Placebo: Cardiovascular Deaths ________________________________________________________________________________________________ 28tbl12.doc Microsoft Word® Document MS Word® 2002 62KB 1 page Contents: Table 12. Risk Ratios for Vitamin E Alone vs. Placebo: Fatal Myocardial infarction ________________________________________________________________________________________________ 29fig11.doc Microsoft Word® Document MS Word® 2002 42KB 1 page Contents: Figure 11. Vitamin E Alone vs. Placebo: Fatal Myocardial Infarction ________________________________________________________________________________________________ 30fig12.doc Microsoft Word® Document MS Word® 2002 36KB 1 page Contents: Figure 12. Publication Bias - Vitamin E Alone vs. Placebo: Fatal Myocardial Infarction ________________________________________________________________________________________________ 31tbl13.doc Microsoft Word® Document MS Word® 2002 56KB 1 page Contents: Table 13. Risk Ratios for Vitamin E in Combination vs. Placebo: Fatal Myocardial infarction ________________________________________________________________________________________________ 32fig13.doc Microsoft Word® Document MS Word® 2002 42KB 1 page Contents: Figure 13. Vitamin E in Combination vs. Placebo: Fatal Myocardial Infarction ________________________________________________________________________________________________ 33fig14.doc Microsoft Word® Document MS Word® 2002 36KB 1 page Contents: Figure 14. Publication Bias - Vitamin E in Combination vs. Placebo: Fatal Myocardial Infarction ________________________________________________________________________________________________ 34tbl14.doc Microsoft Word® Document MS Word® 2002 58KB 1 page Contents: Table 14. Risk Ratios for Vitamin E Alone vs. Placebo: Nonfatal Myocardial infarction ________________________________________________________________________________________________ 35fig15.doc Microsoft Word® Document MS Word® 2002 42KB 1 page Contents: Figure 15. Vitamin E Alone vs. Placebo: Nonfatal Myocardial Infarction ________________________________________________________________________________________________ 36fig16.doc Microsoft Word® Document MS Word® 2002 36KB 1 page Contents: Figure 16. Publication Bias - Vitamin E Alone vs. Placebo: Nonfatal Myocardial Infarction ________________________________________________________________________________________________ 37tbl15.doc Microsoft Word® Document MS Word® 2002 63KB 1 page Contents: Table 15. Risk Ratios for Vitamin E in Combination vs. Placebo: Nonfatal Myocardial infarction ________________________________________________________________________________________________ 38fig17.doc Microsoft Word® Document MS Word® 2002 41KB 1 page Contents: Figure 17. Vitamin E in Combination vs. Placebo: Nonfatal Myocardial Infarction ________________________________________________________________________________________________ 39fig18.doc Microsoft Word® Document MS Word® 2002 36KB 1 page Contents: Figure 18. Publication Bias - Vitamin E in Combination vs. Placebo: Nonfatal Myocardial Infarction ________________________________________________________________________________________________ 40tbl16.doc Microsoft Word® Document MS Word® 2002 76KB 1 page Contents: Table 16. Risk Ratios for Vitamin E Alone vs. Placebo: Total Cholesterol Level ________________________________________________________________________________________________ 41fig19.doc Microsoft Word® Document MS Word® 2002 53KB 1 page Contents: Figure 19. Vitamin E Alone vs. Placebo: Total Cholesterol Level ________________________________________________________________________________________________ 42fig20.doc Microsoft Word® Document MS Word® 2002 37KB 1 page Contents: Figure 20. Publication Bias - Vitamin E Alone vs. Placebo: Total Cholesterol Level ________________________________________________________________________________________________ 43tbl17.doc Microsoft Word® Document MS Word® 2002 74KB 1 page Contents: Table 17. Risk Ratios for Vitamin E Alone vs. Placebo: Low-Density Lipoprotein ________________________________________________________________________________________________ 44fig21.doc Microsoft Word® Document MS Word® 2002 52KB 1 page Contents: Figure 21. Vitamin E Alone vs. Placebo: Low-density Lipoprotein ________________________________________________________________________________________________ 45fig22.doc Microsoft Word® Document MS Word® 2002 37KB 1 page Contents: Figure 22. Publication Bias - Vitamin E Alone vs. Placebo: Low-density Lipoprotein ________________________________________________________________________________________________ 46tbl18.doc Microsoft Word® Document MS Word® 2002 75KB 1 page Contents: Table 18. Risk Ratios for Vitamin E Alone vs. Placebo: High-Density Lipoprotein ________________________________________________________________________________________________ 47fig23.doc Microsoft Word® Document MS Word® 2002 53KB 1 page Contents: Figure 23. Vitamin E Alone vs. Placebo: High-density Lipoprotein ________________________________________________________________________________________________ 48fig24.doc Microsoft Word® Document MS Word® 2002 37KB 1 page Contents: Figure 24. Publication Bias - Vitamin E Alone vs. Placebo: High-density Lipoprotein ________________________________________________________________________________________________ 49tbl19.doc Microsoft Word® Document MS Word® 2002 59KB 1 page Contents: Table 19. Risk Ratios for Vitamin E in Combination vs. Placebo: Total Cholesterol Level ________________________________________________________________________________________________ 50fig25.doc Microsoft Word® Document MS Word® 2002 47KB 1 page Contents: Figure 25. Vitamin E in Combination vs. Placebo: Total Cholesterol Level ________________________________________________________________________________________________ 51fig26.doc Microsoft Word® Document MS Word® 2002 36KB 1 page Contents: Figure 26. Publication Bias - Vitamin E in Combination vs. Placebo: Total Cholesterol Level ________________________________________________________________________________________________ 52tbl20.doc Microsoft Word® Document MS Word® 2002 48KB 1 page Contents: Table 20. Risk Ratios for Vitamin E in Combination vs. Placebo: Low-Density Lipoprotein ________________________________________________________________________________________________ 53fig27.doc Microsoft Word® Document MS Word® 2002 45KB 1 page Contents: Figure 27. Vitamin E in Combination vs. Placebo: Low-density Lipoprotein ________________________________________________________________________________________________ 54fig28.doc Microsoft Word® Document MS Word® 2002 36KB 1 page Contents: Figure 28. Publication Bias - Vitamin E in Combination vs. Placebo: Low-density Lipoprotein ________________________________________________________________________________________________ 55tbl21.doc Microsoft Word® Document MS Word® 2002 49KB 1 page Contents: Table 21. Risk Ratios for Vitamin E in Combination vs. Placebo: High-Density Lipoprotein ________________________________________________________________________________________________ 56fig29.doc Microsoft Word® Document MS Word® 2002 45KB 1 page Contents: Figure 29. Vitamin E in Combination vs. Placebo: High-density Lipoprotein ________________________________________________________________________________________________ 57fig30.doc Microsoft Word® Document MS Word® 2002 35KB 1 page Contents: Figure 30. Publication Bias - Vitamin E in Combination vs. Placebo: High-density Lipoprotein ________________________________________________________________________________________________ 58chap4.doc Microsoft Word® Document MS Word® 2002 24KB 2 pages Contents: Chapter 4. Limitations: Literature, Quality of Trials, Appropriateness of the Intervention and Population, Heterogeneity ________________________________________________________________________________________________ 59chap5.doc Microsoft Word® Document MS Word® 2002 21KB 1 page Contents: Chapter 5. Conclusions ________________________________________________________________________________________________ 60chap6.doc Microsoft Word® Document MS Word® 2002 25KB 2 pages Contents: Chapter 6. Future Research ________________________________________________________________________________________________ 61refs.doc Microsoft Word® Document MS Word® 2002 87KB 15 pages Contents: References ________________________________________________________________________________________________ 62evtbl.doc Microsoft Word® Document MS Word® 2002 1.1MB 56 pages Contents: Evidence Table. Antioxidants for Cardiovascular Prevention and Treatment ________________________________________________________________________________________________ 63biblio.doc Microsoft Word® Document MS Word® 2002 157KB 20 pages Contents: Bibliography ________________________________________________________________________________________________ 64appa.doc Microsoft Word® Document MS Word® 2002 44KB 3 pages Contents: Appendix A. Acknowledgments ________________________________________________________________________________________________ 65appb.doc Microsoft Word® Document MS Word® 2002 46KB 6 pages Contents: Appendix B. Search Methodology ________________________________________________________________________________________________ 66appc.doc Microsoft Word® Document MS Word® 2002 31KB 1 page Contents: Appendix C. Antioxidant Screener ________________________________________________________________________________________________ 67appd.doc Microsoft Word® Document MS Word® 2002 229KB 8 pages Contents: Appendix D. Quality Review Form ________________________________________________________________________________________________ 68appe.doc Microsoft Word® Document MS Word® 2002 215KB 21 pages Contents: Appendix E. Peer reviewer comments and responses ________________________________________________________________________________________________
AHRQ Publication No. 03-E043
Current as of July 2003
Internet Citation:
Effect of Supplemental Antioxidants Vitamin C, Vitamin E, and Coenzyme Q10 for the Prevention and Treatment of Cardiovascular Disease. File Inventory, Evidence Report/Technology Assessment Number 83. AHRQ Publication No. 03-E043, July 2003. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/clinic/aoxcardinv.htm
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