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Guidelines: Vitamins and Cardiovascular-Disease Prevention

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

Does vitamin supplementation help to prevent cardiovascular disease (CVD)? To answer this question, the USPSTF assessed current evidence on vitamins A, C, and E, beta-carotene, multivitamins with folic acid, and antioxidant combinations. After a thorough review of existing observational and clinical trial data, the task force drew these conclusions:

1. Evidence is insufficient to determine if vitamins A, C, or E, multivitamins with folic acid, or antioxidant combinations reduce CVD risk.

2. Beta-carotene should not be used for preventing CVD; it does not decrease risk for CVD, and it may increase risk for lung cancer and all-cause mortality in smokers, especially heavy smokers.

3. Vitamin supplements may nevertheless be beneficial for overall health in patients with dietary insufficiencies. Smokers should not take beta-carotene supplements, however, because of the potential risk.

4. Patients who choose to take vitamins should be encouraged to follow the standard Dietary Reference Intakes of the Institute of Medicine (available at http://www.iom.edu/project.asp?id=4574).

Comment: These USPSTF guidelines conclude that there is a lack of compelling data to show that routine vitamin supplementation is effective for primary or secondary prevention of cardiovascular disease. The guidelines are consistent with a recent meta-analysis of studies on vitamin E and beta-carotene, which suggested that these 2 antioxidants do not reduce CVD risk and that beta-carotene may increase risk for all-cause and cardiovascular mortality (Journal Watch Cardiology Aug 22 2003). Note that these USPSTF guidelines do not assess the role of vitamins for uses other than preventing CVD and cancer.

— JoAnne M. Foody, MD

Published in Journal Watch Cardiology August 22, 2003

Citation(s):

U.S. Preventive Services Task Force. Routine vitamin supplementation to prevent cancer and cardiovascular disease: Recommendations and rationale. Ann Intern Med 2003 Jul 1; 139:51-5.

• Original article (Subscription may be required)
• Medline abstract (Free)

Morris CD and 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 Jul 1; 139:56-70.

• Original article (Subscription may be required)
• Medline abstract (Free)