Cynthia D. Morris, PhD, MPH; Susan Carson, MPH
Disclaimer: The authors of this article are responsible for its contents, including any clinical or treatment recommendations. No statement in this article should be construed as an official position of the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services.
Acknowledgments: The authors thank Janet Allan and Steven Woolf of the U.S. Preventive Services Task Force, Cheryl Ritenbaugh and Kelly Streit of Kaiser Permanente Center for Health Research, and Mark Helfand of the Oregon Health & Science University Evidence-based Practice Center for their contributions to this project.
Grant Support: The study on which this article is based was conducted by the Oregon Health & Science University Evidence-based Practice Center under contract to the Agency for Healthcare Research and Quality (contract no. 290-97-0018, task order 2).
Potential Financial Conflicts of Interest: None disclosed.
Requests for Single Reprints: Cynthia D. Morris, PhD, MPH, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University Evidence-based Practice Center, 3181 SW Sam Jackson Park Road, Mail Code BICC, Portland, OR 97239.
Current Author Addresses: Dr. Morris and Ms. Carson: Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University Evidence-based Practice Center, 3181 SW Sam Jackson Park Road, Mail Code BICC, Portland, OR 97239.
Antioxidant vitamins are thought to play a role in atherosclerosis. Supplementation of these nutrients has been explored as a means of reducing cardiovascular morbidity and mortality.
To assess the evidence of the effectiveness of vitamin supplementation, specifically vitamins A, C, and E; beta-carotene; folic acid; antioxidant combinations; and multivitamin supplements, in preventing cardiovascular disease.
Cochrane Controlled Trials Registry and MEDLINE (1966 to September 2001), reference lists, and experts.
The researchers selected English-language reports of randomized trials and cohort studies that assessed vitamin supplementation in western populations and reported incidence of or death from cardiovascular events. They also included reports of good- or fair-quality clinical trials of primary and secondary prevention and good- or fair-quality prospective cohort studies. Studies that examined only dietary nutrients or did not provide separate estimates for supplements were not included.
Two reviewers abstracted descriptive information and data on cardiovascular outcomes and mortality from included studies. The researchers assessed study quality using predetermined criteria.
Evidence tables were constructed to summarize data from included studies. The researchers summarized the strength, level, and quality of the overall evidence for the effectiveness of each of the vitamin supplements in preventing or treating cardiovascular disease.
Some good-quality cohort studies have reported an association between the use of vitamin supplements and lower risk for cardiovascular disease. Randomized, controlled trials of specific supplements, however, have failed to demonstrate a consistent or significant effect of any single vitamin or combination of vitamins on incidence of or death from cardiovascular disease. Understanding the sources of these differences will permit researchers to better analyze the cohort study data and to better design long-term clinical trials.
Table 1. Cohort Studies of the Association between Vitamin Supplement Use and Cardiovascular Disease Risk
Table 2. Randomized, Controlled Trials of Vitamin Supplementation for Primary Prevention of Cardiovascular Disease
Table 3. Randomized, Controlled Trials of Vitamin Supplementation for Secondary Prevention of Cardiovascular Disease
Table 4. Summary of the Evidence
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Morris CD, Carson S. Routine Vitamin Supplementation To Prevent Cardiovascular Disease: A Summary of the Evidence for the U.S. Preventive Services Task Force. Ann Intern Med. 2003;139:56-70. doi: 10.7326/0003-4819-139-1-200307010-00014
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Published: Ann Intern Med. 2003;139(1):56-70.
Cardiology, Coronary Risk Factors, Guidelines, Prevention/Screening.
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