Supplemental Vitamins and Minerals for CVD Prevention and Treatment

<p dir="ltr">The authors identified individual randomized controlled trials from previous meta-analyses and additional searches, and then performed meta-analyses on cardiovascular disease outcomes and all-cause mortality. The authors assessed publications from 2012, both before and including the U.S. Preventive Service Task Force review. Their systematic reviews and meta-analyses showed generally moderate- or low-quality evidence for preventive benefits (folic acid for total cardiovascular disease, folic acid and B-vitamins for stroke), no effect (multivitamins, vitamins C, D, β-carotene, calcium, and selenium), or increased risk (antioxidant mixtures and niacin [with a statin] for all-cause mortality). Conclusive evidence for the benefit of any supplement across all dietary backgrounds (including deficiency and sufficiency) was not demonstrated; therefore, any benefits seen must be balanced against possible risks.</p><p dir="ltr">Treatment and prevention of micronutrient deficiencies with vitamins and minerals in the last two-and-a-half centuries are among the most dramatic achievements in the history of nutritional science. The treatment of scurvy with citrus fruit (vitamin C) by the British Naval Surgeon James Lind in 1747 was, perhaps, the first clinical trial ever conducted <a href="https://www.jacc.org/doi/10.1016/j.jacc.2018.04.020#bib1" target="_blank">(1)</a>, in which 12 sailors who had scurvy were (presumably randomly) selected to receive 1 of 6 treatments (2 sailors) per treatment. However, interest in micronutrients has shifted recently from prevention of classic deficiency states to prevention of possible subclinical deficiencies and promotion of overall health and longevity using supplemental vitamins and minerals (supplement use). Here, the data are less clear, but supplement use is widespread. Using the National Health and Nutrition Examination Survey data (1999 to 2012) on 37,958 adults, it was estimated that supplement use was high in 2012, with up to 52% of the population taking supplements. Multivitamins were taken by 31% of the population, vitamin D by 19%, calcium by 14%, and vitamin C by 12% <a href="https://www.jacc.org/doi/10.1016/j.jacc.2018.04.020#bib2" target="_blank">(2)</a>. In Europe during this period, the European Prospective Investigation into Cancer and Nutrition (EPIC) data on 36,034 men and women indicated a wide range of supplement use, with a strong north-south gradient that was highest in the north (e.g., Denmark: 51% men, 65.8% women) and lowest in the south (e.g., Greece: 2.0% men, 6.7% women), and with higher supplement use by women <a href="https://www.jacc.org/doi/10.1016/j.jacc.2018.04.020#bib3" target="_blank">(3)</a>. Despite high supplement use by the general public, there is no general agreement on whether individual vitamins and minerals or their combinations should be taken as supplements for cardiovascular disease (CVD) prevention or treatment. Only the Canadian Cancer Society recommends a supplement (1,000 IU vitamin D to be taken in fall and winter) <a href="https://www.jacc.org/doi/10.1016/j.jacc.2018.04.020#bib4" target="_blank">(4)</a>. What is generally recommended internationally is consumption of a good diet as part of a healthy lifestyle. The recent science-based report of the U.S. Dietary Guidelines Advisory Committee, also concerned with CVD risk reduction, recommended 3 dietary patterns: 1) a healthy American diet low in saturated fat, trans fat, and red meat, but high in fruit and vegetables; 2) a Mediterranean diet; and 3) a vegetarian diet <a href="https://www.jacc.org/doi/10.1016/j.jacc.2018.04.020#bib5" target="_blank">(5)</a>. These diets, with their accompanying recommendations, continue the move toward more plant-based diets that are relatively rich in vitamins and minerals, which liberally satisfies requirements (Dietary Reference Intakes) but which are still below the tolerable upper levels of intake of the recommended range in which adverse effects may be seen. Thus, for the general public, the focus has been on meeting requirements through diet, rather than supplements.Therefore, we reviewed the evidence for supplement use over the last 4 years since the publication of the evidence <a href="https://www.jacc.org/doi/10.1016/j.jacc.2018.04.020#bib6" target="_blank">(6)</a> and guidelines <a href="https://www.jacc.org/doi/10.1016/j.jacc.2018.04.020#bib7" target="_blank">(7)</a> for supplement use of the U.S. Preventive Services Task Force (USPSTF).<br></p>