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Vitamin and Mineral Supplements for Primary Prevention of Cardiovascular Disease and Cancer

Guideline Watch |
May 8, 2014

Vitamin and Mineral Supplements for Primary Prevention of Cardiovascular Disease and Cancer

  1. Jamaluddin Moloo, MD, MPH

The U.S. Preventive Services Task Force recommends against vitamin E supplements and notes that evidence is insufficient to support multivitamin use.

  1. Jamaluddin Moloo, MD, MPH

Sponsoring Organization: U.S. Preventive Services Task Force (USPSTF)

Background and Objective

A sizable proportion of U.S. adults take vitamin and mineral supplements for presumed health benefits. In 2003, the USPSTF issued recommendations on vitamin supplementation to prevent cardiovascular (CV) disease or cancer (Ann Intern Med 2003; 139:51) and concluded that evidence was insufficient to recommend for or against vitamins A, C, or E; multivitamins with folic acid; or antioxidant combinations. It recommended against β-carotene supplementation, because evidence showed that such supplementation did not prevent CV disease or cancer and might confer excess risk for lung cancer. For the 2014 recommendation statement, the USPSTF reviewed studies published since 2003. The reviewers did not evaluate doses higher than tolerable upper intake levels as determined by the Institute of Medicine's Food and Nutrition Board or supplementation in pregnant women or adults with special nutritional needs.

Key Points

  • Substantial and consistent evidence shows that vitamin E supplementation has no effect on CV disease, cancer, or mortality. Not recommended (Grade: D)

  • Supplementation with β-carotene does not lower risk for CV disease or cancer, and it confers excess risk for lung cancer among patients at high risk for the disease (e.g., smokers, people exposed to asbestos). Not recommended (Grade: D)

  • Evidence is insufficient to determine if supplementation with multivitamins or single vitamins or minerals (except vitamin E and β-carotene) lowers risk for CV disease or cancer. Evidence is insufficient to assess the balance of benefits and harms of such supplementation. No recommendation (Grade: I [no recommendation])

What's Changed

In the current review, the Task Force evaluated additional supplements, including vitamin D, calcium, selenium, and folic acid. New evidence increases certainty that vitamin E does not prevent CV disease or cancer.

Comment

Vitamins and minerals are essential to overall health, but evidence is insufficient to suggest substantial benefits or harms from supplements in healthy adults who consume a reasonably balanced diet. At this time, no simple alternative to consuming a balanced diet exists. These recommendations are unlikely to impact the many billions of dollars spent annually on vitamin and mineral supplements.

  • Disclosures for Jamaluddin Moloo, MD, MPH at time of publication Grant / research support NIH

Citation(s):

Reader Comments (3)

David Keller MD MS FACP Physician, Internal Medicine, Outpatient

Please read my Open Letter to the USPSTF which points out that the 2 high quality trials which have been done both prove that multivitamin supplements significantly reduced the risk of cancer in men and, in the study using higher dose vitamins, the overall death rate was significantly reduced for men. I also refute the USPSTF's nonsense objections to recommending multivitamins for men over 50. They are ignoring the evidence and dodging my arguments, which trounced their indecisiveness on the issue. Click this PubMed link and refute my arguments if you can:

http://www.ncbi.nlm.nih.gov/pubmed/24566474#cm24566474_4093

GEORGE KENT Physician, Psychiatry, No place, retired

Finally the truth is out.

BJ Tyler Other, Other

Nothing replaces a whole food, organic, non GMO diet. No supplement can replace what nature created. How many people actually eat like that? Not to mention our current farming practices have created low nutrient dense foods. It was the medical community that came out with the flawed low fat, high carb diet. See how well that worked. Made billions for the drug companies. There are many medical conditions caused by our very poor, western, chemical filled diets. A wholefood diet along with high quality supplements have a better chance of curing our most common diseases. Drugs do not cure anything. They treat symptoms. Diet and lifestyle changes can actually reverse and cure disease.

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