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Vitamins E and C in the Prevention of Cardiovascular Disease in Men


The present description is concerned with highlighting two papers by comparing and contrasting the research and analysis. The first paper was focused on the survey program to determine the utility of complementary and alternative medicines (CAM) in Australia. The second paper was focused to determine if supplementation of vitamin E or C for a prolonged period would lessen the threat of chief cardiovascular events in male individuals. The first paper is a Longitudinal Study of Ageing which began in 1992 and continued till 2004 to better obtain sound data in 4 approaches.

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The second paper is a Physicians’ Health Study II (PHS II) that was undertaken in a randomized, double-blind, placebo-controlled factorial trial manner on the role of vitamins E and C. It began in 1997 and continued till 2007. In the first study, nearly 2087 adults aged 65 years and above who were staying in the community or residential aged care were selected. In the second study, nearly 14,641 U.S. male physicians aged 50 years and above were selected. This included 754 (5.1%) men with prevalent CVD at randomization. In the first paper, findings revealed that the utility of CAM or OTC was recorded to be 17.7% during 2000-2001. This increased during 2003-2004 to 35.5% The utility of important classes of CAM and OTC medicines did not change during the study period indicating the stability. In addition to vitamins, the CAM’s more often used components were found to be herbal drugs and nutritional products, whereas the frequent OTC’s were found to be aspirin at small doses and analgesic drugs.

It was revealed that females and those with younger age were more susceptible to CAM usage in contrast to OTC. In the second paper, the findings revealed that vitamin E does not influence the incidence of major cardiovascular events, total MI, total stroke and cardiovascular mortality. Similarly, vitamin C does not produce any significant effect on major cardiovascular events MI, total stroke and cardiovascular mortality. These two vitamins also did not correlate significantly with total mortality. However, vitamin E was related to an increased risk of hemorrhagic stroke.

Therefore, the paper that was identified for critical analysis was that of Vitamins E and C in the Prevention of Cardiovascular Disease in Men. This is because the health benefits of vitamin E and C supplementation in preventing CVD are still in debate due to inconsistent reports. The problem of CVD in US men has also become a problematic issue. Hence there is a need for a thorough analysis of studies that furnish insights on the significant rile of vitamin supplementation. Moreover, as vitamins are safer in contrast to drug therapy, choosing the strategy of vitamin supplementation is the best one to be considered for an investigation, analysis and review. In view of this, various articles have been identified that would be highlighted to support the description of the paper.


The role of an introduction in a research paper is to present a background of the information related to the proposed area of investigation. This could begin with the particular area from where the research has initiated, data on earlier studies accumulated to date. Then the next aspect is to highlight the problems like controversies, debates or uncertainties that were entangling the area for a certain period. Then emphasize this problem by establishing a connection with the objective or aim. Therefore, the hypothesis or aim of a paper/research project is to give precise information on the problem and state the feasibility of whether it could be addressed or not with a suitable approach. The objective then becomes clear with a statement that an appropriate strategy or investigation was chosen to determine the problem. The chosen paper is in agreement with the role and purpose of the introduction. This could be because the paper has very well highlighted the background information and uncertainties.

It has made an in-depth analysis of earlier studies by giving the time period (1999-2000) and the findings obtained at that time. In addition, it has also provided basic information with regard to the subject by suggesting that vitamins E, C, and other antioxidants would minimize cardiovascular disease (CVD) by blocking organic free radicals and/or inactivating oxygen molecules to inhibit tissue injury. The structure of the paper is well represented. It has given a good beginning to the paper by highlighting the debate regarding the intake of vitamins in the face of uncertainties, and information on the role of vitamins and their antioxidant properties and their relevance to cardiovascular problems. The structure has also emphasized the priority that should be given to the study. Therefore, the quality of the introduction in the paper is deeply rooted in that it has furnished better insights on the functional aspects of vitamins C and E, their public health implications. The connection between the research problem and the objectives could seem to further strengthen the quality of the introduction. The chosen paper has a clearly set out aim.

Keeping in view of the background information and the problem, the researchers have perfectly designed the Study known as the Physicians’ Health Study II (PHS II) in order to give new and clinically reliable information on the individual effects of vitamin E and vitamin C supplementation on the risk of major cardiovascular events among 14,641 male physicians at lower initial risk of CVD in contrast to the earlier experiments. The aim of the paper is to furnish useful information on the beneficial role of vitamin E and vitamin C supplementation by relating with the major cardiovascular problems. The presented literature adequately supports the presented aim. This is because it has initially provided functional relevance of vitamins C and E to draw attention and made an association with the earlier controversies. This probably has not only shed light on the subsequent parts of the literature but also established a tight connection with the scientific description imminent in the aim.

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Methodology and analysis

The method that has been used as part of the research design is that quantitative one that has a randomized, double-blind, placebo-controlled factorial trial. This was done to determine the balance of harmful and beneficial role of vitamins E,C and multivitamins in the prevention of cancer and CVD in 14,641 U.S. male physicians. The method known as the Physicians Health Study (PHS) II study design was undertaken in two phases. The method included was the eligibility condition where the men participants should have a history of cardiovascular events with stroke for PHS II.

This is the most appropriate methodology to be used. This could be because of reliability in designing the study and the time period set for the data collection. Earlier a study conducted to determine the Association of, vitamins C and E supplementation with that of ischemic heart disease (IHD) and stroke has yielded inconsistent information (Dagenais, et a., 2000). These controversies are better addressed with the present methodology. Hence, the type of data that was collected was of follow- up one related to ten years, and outcome of events of men. This was related to major cardiovascular events, total myocardial infarction, total stroke, cardiovascular mortality, baseline characteristics as per vitamin C and E treatment plan, and overall association of vitamins to the cardiovascular events.

The experimental data was represented as totals and percentages in parentheses for several baseline characteristics. For representing the association between randomized vitamin E and vitamin C assignment and the risk of major cardiovascular events and mortality, the data was focused on the outcome of events under investigation and a comparison between active and placebo groups. A 95% CI analysis was done for assessing the hazard ratio. This was also done for obtaining information on the outcome of events according to baseline characteristics and treatment assignment in the study. A 95% CI analysis was done for assessing hazard ratio but with P interaction.

As such, the analysis is in agreement with the study design and hence is appropriate. The analysis has been undertaken well as it incorporated tools like 95 % CI and P interaction in assessing the cardiovascular risk in active and placebo groups. The analysis revealed no significant association between the vitamins E, C and the risk of cardiovascular events and mortality. However, the analysis could have been improved by incorporating additional parameters like C – reactive protein (CRP) which is widely considered as the good marker of cardiovascular inflammation. A correlation with CRP could have yielded significant information on the role of vitamins C and E with reference to cardiovascular


Next, validity and reliability are important for the research. This is to generate scientific cogency presented in the paper which plays important role in strengthening the data. This would be accepted by a wide group of audience who may evaluate the paper critically in terms of risk-benefit ratio, controversies addressed, reproducibility and its future implications. Hence, in the chosen paper, the validity and reliability stem from the large sample size and the time period that have become an integral part. Secondly, the basic information on the functional properties of vitamin C and E, comparison between active and placebo groups, the CI levels, etc have made the paper valid and reliable. More probably, the study treatment, follow-up, and compliance were well set and reliable. This was made feasible through recently known risk contributors, novel endpoints that take place and questionnaires. The therapy that began in the blinded fashion of the vitamin E and C components of PHS II has a follow-up and validated report of endpoints through September 2008.

Therefore, the validity and reliability of the paper were very well presented. The method/methodology that has been used as part of the research design is that of recruitment, enrollment of participants and randomization of men. The methodology employed informing the placebo and active group of participants about daily and alternative intake of vitamin E and C through calendar packs annually.

The method of interviewing through questionnaires is a vital component of the methodology part.

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Next, the method also consisted of a follow-up program which has yielded vital information on the continuity of vitamins intake, potential adverse events, the occurrence of new endpoints, and updated risk factors.


The conclusion of the paper is in agreement with the data presented in the paper. This was revealed from the findings that supplementation of vitamins E and C did not produce any significant reduction of major cardiovascular events in the long-term Randomized Trials of male physicians. Similarly, from the data, the vitamins have no effect on myocardial infarction, total stroke, cardiovascular death, congestive heart failure, and total mortality. The researcher has also concluded well on vitamin E due to its increasing effect on hemorrhagic stroke. Therefore, the conclusion of the paper has the right information in addressing the aim. This could be justified from the concluding remarks that long-term supplementation of vitamins E or C did not produce a lessening effect on major cardiovascular events among men. This was strongly connected to the objective under investigation.

Further, the ethical issues raised by the paper have no connection with the resources or any funding bias. The participants have been provided informed consent and there was no external pressure of any kind to draw the attention of participants for the study. Hence, ethical issues have not been highlighted. The results of the research have shed light with regard to the baseline characteristics. This could be due to the fact that the theses are essential to undertake the study in long-term randomized clinical trials similar to that of the present study. Especially, this has indicated that there is a need to consider earlier drug history specific to Aspirin, smoking, exercise, and alcohol consumption. Since these components may interfere with the results, their evaluation is necessary. Similarly, the role of hypertension, cholesterol, diabetes has also yielded good information indicating that their inclusion is a must in studies the focus on the major cardiovascular events.

The information obtained from the paper could be utilized well for reproducing the experiment in our clinic. For example, the patients attending the routine diabetic clinic have been ruled out for cardiovascular risk. These patients could be selected and an intervention program could be devised to look for the beneficial effects of vitamin C and E supplementation. Screening of patients who run a high risk of cardiovascular complications would be given prior importance in our clinic. This makes our eligibility criteria reliable and valid. This could be reflected as a personal reflection. This is because the outcome of the study is reliable and has future implications on the role of vitamins E and C in a good number of participants (Jha, et al., 1995).

Earlier findings have been under debate whether vitamins E and C have beneficial or no effect on cardiovascular events (Dagenais, et al., 2000). In an epidemiologic study, it was suggested that vitamins with antioxidant properties lessen cardiovascular disease especially with regard to vitamin E(Jha, et al., 1995). But Full randomized trials do not support this research. Hence, controversy has been initiated and need to be addressed should by a large-scale and long-term randomized trial set particularly to determine the role of vitamins E and C in cardiovascular disease (Jha, et al., 1995).


Dagenais, G.R., Marchioli, R., Yusuf, S., Tognoni, G. 2000. Beta-carotene, vitamin C, and vitamin E and cardiovascular diseases. Curr Cardiol Rep,2(4),pp. 293-9. Web.

Jha, P., Flather, M., Lonn, E., Farkouh, M., Yusuf, S. 2000. The antioxidant vitamins and cardiovascular disease. A critical review ofepidemiologic and clinical trial data. Ann Intern Med, 123(11), pp. 860-72. Web.

Lynn Yeen Goh, Agnes I Vitry, Susan J Semple, Adrian Esterman, Mary A Luszcz. 2009. Self-medication with over-the-counter drugs and complementary medications in South Australia’s elderly population. BMC Complementary and Alternative Medicine, 9: 42.

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StudyCorgi. (2022, March 19). Vitamins E and C in the Prevention of Cardiovascular Disease in Men. Retrieved from


StudyCorgi. (2022, March 19). Vitamins E and C in the Prevention of Cardiovascular Disease in Men.

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