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Comparative efficacy of tocotrienol and tocopherol (vitamin E) on atherosclerotic cardiovascular diseases in humans.

  • 2024-05-24
  • JPMA. The Journal of the Pakistan Medical Association 74(6)
    • Saima Rafique
    • Dilshad Ahmed Khan
    • Kulsoom Farhat
    • Muhammad Asghar Khan
    • Mudassar Noor
    • Mahjabeen Sharif

Study Design

Type
Systematic Review
Population
patients with atherosclerotic cardiovascular diseases
Methods
Systematic review in line with PRISMA 2020 guidelines; literature search from 2002 till January 5, 2023 on multiple databases

Objective

To compare the efficacy of tocotrienol and tocopherol in the management of patients with atherosclerotic cardiovascular diseases.

Methods

The systematic review was conducted in line with Preferred Reporting Items for Systematic Reviews and Meta- Analyses guidelines 2020, and comprised literature search from 2002 till January 5, 2023, on PubMed, Google Scholar, Cochrane Library, Google, Wiley-Inter Science Library, Medline, SpringerLink, Taylor and Francis databases. The search was conducted using key words, such as: "tocopherol", "tocotrienol", "vitamin E", "dyslipidaemia", "cardiovascular diseases" "cardioprotective", "hypercholesterolemia" and "atherosclerosis" along with Boolean operators. Human clinical studies regarding the use of tocotrienol or tocopherol or comparison of its efficacy in patients having atherosclerosis, dyslipidaemia leading to cardiovascular diseases, and studies including details of efficacy of any of the four alpha, beta, gamma, delta isomers of tocopherol or tocotrienol were included. Pertinent data from the eligible studies was retrieved and reviewed.

Results

Of the 516 articles identified, 26 (5%) articles met eligibility criteria. Of them 5(19%) were subjected to detailed analysis. Tocotrienol showed significant anti-oxidant efficacy at (250 mg/d) by decreasing cholesterol and serum inflammatory biomarkers i.e C-reactive protein (40%), malondialdehyde (34%), gamma-glutamyl transferase (22%) (p<0.001). Total anti-oxidant status (TAS) levels raised 22% (p<0.001) and Inflammatory cytokines i.e resistin, interleukin (IL)-1, IL-12, Interferon-gamma were decreased 15-17% (p<0.05-0.01) respectively by tocotrienol. Several microRNA (miRNA-133a, miRNA-223, miRNA-214, miRNA-155) were modulated by δ-tocotrienol. Whereas, tocopherol showed heterogeneity of results by either decreasing or increasing the risk of mortality in atherosclerotic cardiovascular diseases.

Conclusion

Compared to tocopherol, tocotrienol was found to be safe and potential candidate for improving cardiovascular health in the management of atherosclerotic cardiovascular diseases.

Research Insights

  • Vitamin E→Decreased Gamma-glutamyl Transferase Level

    Tocotrienol showed significant anti-oxidant efficacy at (250 mg/d) by decreasing cholesterol and serum inflammatory biomarkers i.e C-reactive protein (40%), malondialdehyde (34%), gamma-glutamyl transferase (22%) (p<0.001).

    Effect
    Beneficial
    Effect size
    Moderate
    Dose
    250 mg/d
  • Vitamin E→Decreased Interferon-Gamma Level

    Total anti-oxidant status (TAS) levels raised 22% (p<0.001) and Inflammatory cytokines i.e resistin, interleukin (IL)-1, IL-12, Interferon-gamma were decreased 15-17% (p<0.05-0.01) respectively by tocotrienol.

    Effect
    Beneficial
    Effect size
    Small
    Dose
    250 mg/d
  • Vitamin E→Decreased Interleukin-1 Level

    Total anti-oxidant status (TAS) levels raised 22% (p<0.001) and Inflammatory cytokines i.e resistin, interleukin (IL)-1, IL-12, Interferon-gamma were decreased 15-17% (p<0.05-0.01) respectively by tocotrienol.

    Effect
    Beneficial
    Effect size
    Small
    Dose
    250 mg/d
  • Vitamin E→Decreased Malondialdehyde Level

    Tocotrienol showed significant anti-oxidant efficacy at (250 mg/d) by decreasing cholesterol and serum inflammatory biomarkers i.e C-reactive protein (40%), malondialdehyde (34%), gamma-glutamyl transferase (22%) (p<0.001).

    Effect
    Beneficial
    Effect size
    Moderate
    Dose
    250 mg/d
  • Vitamin E→Decreased Resistin Level

    Total anti-oxidant status (TAS) levels raised 22% (p<0.001) and Inflammatory cytokines i.e resistin, interleukin (IL)-1, IL-12, Interferon-gamma were decreased 15-17% (p<0.05-0.01) respectively by tocotrienol.

    Effect
    Beneficial
    Effect size
    Small
    Dose
    250 mg/d
  • Vitamin E→Increased Antioxidant Enzyme Levels

    Total anti-oxidant status (TAS) levels raised 22% (p<0.001) and Inflammatory cytokines i.e resistin, interleukin (IL)-1, IL-12, Interferon-gamma were decreased 15-17% (p<0.05-0.01) respectively by tocotrienol.

    Effect
    Beneficial
    Effect size
    Moderate
    Dose
    250 mg/d
  • Vitamin E→Reduced C-Reactive Protein Level

    Tocotrienol showed significant anti-oxidant efficacy at (250 mg/d) by decreasing cholesterol and serum inflammatory biomarkers i.e C-reactive protein (40%), malondialdehyde (34%), gamma-glutamyl transferase (22%) (p<0.001).

    Effect
    Beneficial
    Effect size
    Large
    Dose
    250 mg/d
  • Vitamin E→Reduced Interleukin-12 Level

    Total anti-oxidant status (TAS) levels raised 22% (p<0.001) and Inflammatory cytokines i.e resistin, interleukin (IL)-1, IL-12, Interferon-gamma were decreased 15-17% (p<0.05-0.01) respectively by tocotrienol.

    Effect
    Beneficial
    Effect size
    Small
    Dose
    250 mg/d
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