Selenium and vitamin E supplements for prostate cancer: Evidence or embellishment?
Selenium and vitamin E supplements for prostate cancer: Evidence or embellishment?
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DOI：
10.1016/s0090-4295(01)01190-6
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发表时间：
2002-04-01
期刊：
影响因子：
2.1
通讯作者：
Moyad, MA
中科院分区：
文献类型：
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作者：
Moyad, MA
硒和维生素E可能是最受欢迎的2种膳食补充剂，被认为可用于降低前列腺癌风险。这种热情反映在硒和维生素E化学预防试验（SELECT）的启动。是否有足够的证据支持在大规模的前瞻性试验中使用这些补充剂来降低前列腺癌的风险？许多实验室和观察性研究的结果支持使用这些补充剂，最近的前瞻性试验数据也提供了部分支持。然而，对数据的更仔细分析揭示了一些有趣和独特的关联。硒补充剂只对那些基线血浆硒水平较低的人有益。其他受试者，正常或更高水平，没有受益，可能有前列腺癌的风险增加。补充剂仅在风险较高和/或这些化合物的血浆水平较低的人群中降低前列腺癌风险的概念得到了检查β-胡萝卜素补充剂的试验的支持。吸烟者可能是唯一受益的人，补充维生素E也显示了这一点。在最近的4项前瞻性研究中，发现维生素E可以降低过去/最近和当前吸烟者以及这种维生素水平低的人患前列腺癌的风险。过去的一项前瞻性研究表明，高剂量（大于或等于100 IU）的维生素E补充剂也与非吸烟者患侵袭性或致命性前列腺癌的风险较高相关。SELECT试验中维生素E的剂量（400 IU/天）比最大的随机前瞻性试验（其中前列腺癌的发病率用作终点）所建议的有效剂量（50 IU/天）高8倍。最近的研究还表明，膳食维生素E可能与维生素E补充剂相比，患前列腺癌的风险较低。此外，过去所有心血管前瞻性随机试验的最新结果表明，维生素E对心血管疾病风险几乎没有什么益处，尤其是在剂量方面。正在使用的选择试验。过去对补充剂的前瞻性研究的其他有趣的积极发现表明，阿司匹林和其他非甾体抗炎药在降低前列腺癌或其他类型癌症（如结肠癌）的风险方面具有作用。也许是时候进行一个大规模的昂贵的试验，重新考虑使用硒和维生素E补充剂来降低前列腺癌的风险。使用这些补充剂的一些证据存在，但严重的修饰研究结果可能会导致这些补充剂在临床环境中的不适当使用。(C)2002年，Elsevier Science Inc.
Selenium and vitamin E are probably 2 of the most popular dietary supplements considered for use in the reduction of prostate cancer risk. This enthusiasm is reflected in the initiation of the Selenium and Vitamin E Chemoprevention Trial (SELECT). Is there sufficient evidence to support the use of these supplements in a large-scale prospective trial for patients who want to reduce the risk of prostate cancer? Results from numerous laboratory and observational studies support the use of these supplements, and data from recent prospective trials also add partial support. However, a closer analysis of the data reveals some interesting and unique associations. Selenium supplements provided a benefit only for those individuals who had lower levels of baseline plasma selenium. Other subjects, with normal or higher levels, did not benefit and may have an increased risk for prostate cancer. The concept that supplements reduce prostate cancer risk only in those at a higher risk and/or those with lower plasma levels of these compounds is supported by trials examining beta-carotene supplements. Smokers may be the only individuals who benefit, as has also been shown with vitamin E supplementation. In 4 recent prospective studies, vitamin E was found to reduce the risk of prostate cancer in past/recent and current smokers and those with low levels of this vitamin. Vitamin E supplements in higher doses (greater than or equal to 100 IU) were also associated with a higher risk of aggressive or fatal prostate cancer in nonsmokers from a past prospective study. The dose of vitamin E in the SELECT trial (400 IU/day) is 8 times higher than what has been suggested to be effective (50 IU/day) by the largest randomized prospective trial in which the incidence rate of prostate cancer was used as an endpoint. Recent research also suggests that dietary vitamin E may be associated with a lower risk of prostate cancer than the vitamin E supplement, Additionally, recent results from all past cardiovascular prospective, randomized trials suggest that vitamin E shows little benefit for cardiovascular disease risk, especially at the dose being used in the SELECT trial. Other intriguing positive findings from past prospective studies of supplements suggest that aspirin and other nonsteroidal anti-inflammatory drugs have a role in reducing the risk of prostate cancer or other types of cancer (eg, colon cancer). it may be time to conduct a large costly trial to reconsider the use of selenium and vitamin E supplements for the reduction of prostate cancer risk. Some evidence for the use of these supplements exists, but serious embellishment of study findings may be leading to an inappropriate use of these supplements in a clinical setting. (C) 2002, Elsevier Science Inc.