Clinical Question

Do daily multivitamin supplements reduce the risk of cardiovascular disease and subsequent mortality in adult men?

Bottom Line

Daily multivitamin supplementation does not reduce the risk of major cardiovascular events in men. The risks of cardiovascular-related mortality and all-cause mortality were also not reduced by multivitamin supplementation. (Level of Evidence = 1b –)

Synopsis

As part of the Physicians' Health Study, which evaluated various health interventions, including aspirin, vitamin E, and beta carotene, these investigators analyzed separate data on the potential value of daily multivitamin supplements in reducing major cardiovascular disease events. Eligible men (n = 14,641) 50 years or older randomly received (uncertain allocation concealment) a common daily multivitamin supplement (Centrum Silver) or a matched placebo. Of these, 5.1% had a history of cardiovascular disease and 9.0% had a history of cancer. Approximately 40% were former smokers, and only 3.6% were current smokers. Individuals masked to treatment group assignment assessed outcomes, including all cancer and mortality end points. Complete follow-up occurred for more than 98% of participants for a median of 11.2 years.

Using intention-to-treat analysis, the authors report no significant effect of a daily multivitamin on major cardiovascular events, including total myocardial infarction, stroke, or cardiovascular-related mortality. There was also no significant difference in all-cause mortality. Results were similar for the subset of patients with a history of cardiovascular disease.

Reference

SessoHDChristenWGBubesVet alMultivitamins in the prevention of cardiovascular disease in men. The Physicians' Health Study II randomized controlled trial. JAMA.2012; 308( 17): 1751– 1760.

Funding source: Government

Study design: Randomized controlled trial (double-blinded)

Allocation: Uncertain

Setting: Population-based