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To the Editor: Dr Bjelakovic and colleagues¹ showed that there is no evidence from randomized trials that antioxidant supplements reduce mortality. However, the authors did not consider that the effects might vary among different population subgroups so that an average for a large group of people could be misleading.

Analyses of the large-scale Alpha-Tocopherol Beta-Carotene (ATBC) Cancer Prevention Study found substantial divergence in the effect of 50 mg/d of vitamin E on common cold incidence in elderly men. Among participants 72 years or older, who smoked heavily, and lived outside cities, use of vitamin E increased common cold incidence by 58% (95% confidence interval [CI], 23%-101%; 0.83 vs 0.53 colds per year), whereas in less-smoking city-dwellers it reduced common cold incidence by 46% (95% CI, –20% to –63%; 0.47 vs 0.86 colds per year).² The effect of vitamin E on the incidence of pneumonia also diverged so that the risk . . . [Full Text of this Article]

Harri Hemilä, MD, PhD
harri.hemila@helsinki.fi
Department of Public Health
University of Helsinki
Helsinki, Finland

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