In this study, neither vitamin C nor vitamin E supplements reduced the risk of major cardiovascular events, even after more than a decade of treatment and follow-up.419,420 Among 12064 MI survivors, a placebo-controlled trial demonstrated that supplementation with folic acid and vitamin B12 also did not have beneficial effects on cardiovascular outcomes.421 This was confirmed in a meta-analysis of >37000 participants that demonstrated that high-dose B vitamins and folic acid are not effective as a secondary prevention measure for cardiovascular disease.422 Finally, a meta-analysis of 50 randomized, controlled trials with nearly 300000 participants showed no benefit of vitamin and antioxidant supplementation in reducing the risk of major cardiovascular events, including subgroup meta-analyses examining the effects of individual vitamins.423 Undergoing cardiac surgery leads to considerable stress on the body, which plays a key factor in determining outcome. Along with weight loss and protein catabolism, cardiac sur- gery is often associated with numerous derangements in stored vitamin and other metabolite levels. CABG is accompanied by a significant acute phase and inflammatory response, lead- ing to oxidative stress, free radical production, and antioxi- Louw and coworkers427 observed that this early acute-phase reaction was associated with decreases in the levels of both vitamin A and vitamin C, which are impor- tant antioxidants that aid in wound healing. Interestingly, both vitamin levels returned to normal after surgery without specific therapeutic intervention. Schindler and colleagues428 studied serial plasma samples before, during, and up to 48 hours after surgery, demonstrating significant decreases in levels of both vitamin A and vitamin E, with persistently low vitamin E levels 48 hours postoperatively. 