Dietary Vitamin E Intake and Ischemic Heart Disease Mortality: A 28-Year International Spatiotemporal Ecological Study

Background Vitamin E (VE) is associated with various chronic diseases. Observational studies have suggested an inverse association between VE intake and ischemic heart disease (IHD) risk; however, randomized controlled trials and Mendelian randomization analyses have shown no preventive or even harmful effects. Most previous studies have focused on Western populations, leaving the effects of dietary VE underexplored in other contexts. Objectives This study aimed to address these gaps by using 28 years of global data (1990–2018) to examine the country-level ecological associations of dietary VE on IHD from a public health perspective. Methods Data on IHD incidence (IHDi) and mortality (IHDd) were derived from the Global Burden of Disease 2021, whereas data on dietary VE intake were obtained from the Global Dietary Database. Longitudinal associations between VE intake and IHD were analyzed using linear mixed models, controlling sociodemographic and lifestyle covariates. Risk ratios (RRs) were derived from log-transformed dependent variables. Results Dietary VE intake was not significantly associated with IHDi (β = 0.005, p=0.235), whereas it showed a small positive association with IHDd (β = 0.011, p=0.031). Consistent results for β coefficients and RRs were obtained using median intake. The increase in RRs for IHDd at the 90th percentile (RR = 1.049; 95% confidence interval, 1.004–1.096) was modest. Conclusion This 28-year spatiotemporal ecological analysis showed that dietary VE intake was not associated with IHDi but showed a modest positive association with IHDd at the country-level. These findings should be interpreted as ecological associations rather than evidence of individual-level or causal effects.