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 "There is no scientific evidence that (these) supplements promote
cardiovascular health," lead author Dr. Joonseok Kim from University
of Alabama at Birmingham told Reuters Health by email. "We hope that
our paper helps to settle the debate" on the use of multivitamins
and minerals (MVM) for cardiovascular disease prevention.
Americans spent an estimated $36.1 billion on vitamins and
nutritional supplements in 2017, and many believe that MVM
supplements maintain and promote health by preventing various
diseases, including cardiovascular disease. Most large-scale
studies, however, have found no such benefit.
Kim's team pooled evidence from 18 studies with more than 2 million
participants to investigate associations between MVM supplementation
and various cardiovascular problems, including coronary heart
disease and stroke.
Use of MVM supplements was not associated with the risk of death
from cardiovascular disease or coronary heart disease, or stroke
incidence or deaths, according to the report in Circulation:
Cardiovascular Quality and Outcomes.
MVM supplements were associated with a slightly lower risk of
developing coronary heart disease, but this difference was observed
only in studies that did not account for fruit and vegetable intake
and in studies conducted outside the U.S. The studies done in the
U.S., and those that did factor in diet, found no statistically
meaningful benefit from MVM supplements in preventing heart disease.
The results were consistent when researchers adjusted for other
factors, such as follow-up duration, age, sex, physical activity,
and so on.
"We learned from previous experiences that it is immensely difficult
to influence the public when there is a strong preconception and
commercial profits at stake," Kim noted. "However, I believe
healthcare professionals and researchers now have the evidence to
educate the public with correct information and focus on more
pressing questions for effective CVD prevention," he said.
"I would like to encourage people to discuss the use of MVM
supplements with their physicians and reallocate their resources to
something that is proven to improve cardiovascular outcomes, such as
fruit and vegetable intake and exercise."
Dr. Susanne Rautiainen from Karolinska Institutet in Stockholm, who
has extensively studied the use of MVM and disease prevention but
was not involved in the review, told Reuters Health, "Hopefully the
results influence physicians to not recommend multivitamins to their
patients that are apparently healthy."
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The research community has been "quite active for a long time
informing about the no associations among healthy populations, but
still the sales of dietary supplements continue to increase, with
multivitamin supplements among the most popular ones. But we will
continue our work informing the society about the right facts," she
said in an email.
"This systematic review mainly included healthy populations, meaning
that if you consider yourself healthy with no history of disease and
a well-balanced diet characterized by high intakes of fruits and
vegetables, whole grains, legumes, nuts, and fish, there is no
reason to spend money on multivitamin supplements."
Very little is known about how multivitamin use affects populations
with a previous history of cardiovascular disease, older
populations, and those with poor baseline nutritional status, for
example, she noted. "But based on the research done so far, there is
no reason to take a multivitamin to reduce your risk of developing
CVD."
On the other hand, notes Dr. Jeffrey B. Blumberg of the Jean Mayer
USDA Human Nutrition Research Center on Aging at the Friedman School
of Nutrition Science and Policy of Tufts University in Boston,
multivitamins and minerals may still serve some purpose.
"It is interesting to me that questions about MVM and other nutrient
supplements always seems focused on the medical model of preventing
or treating disease (something which dietary supplements are not
allowed to claim per FDA/FTC regulations), rather than on whether
they effectively and/or efficiently do what they claim to do, i.e.,
supplement the diet with essential vitamins and minerals that have
been found to be 'underconsumed' (according to the 2015-2020 Dietary
Guidelines for Americans) . . . in many Americans," he said in an
email.
For example, he noted, 90 percent of people in the U.S. fail to meet
the Estimated Average Requirement for potassium, vitamins D and E
and choline.
"The inadequate intake of these micronutrients creates a 'hidden
hunger' that could be partly addressed by supplements like MVM and
correct the associated less-than-optimal daily structure/function of
our cells and physiological systems," said Blumberg, who wasn't
involved with the review.
SOURCE: https://bit.ly/2m6Q219 and https://bit.ly/2KLbbwM
Circulation: Cardiovascular Quality and Outcomes, online July 10,
2018.
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