In the Journals

Multivitamin use fails to lower risk for CVD in older men

Dietary intake did not affect the risk for heart disease in middle-aged and older men who were taking multivitamins, according to a study published in JAMA Cardiology.

Multivitamin supplements are taken by more than 50% of older adults in the United States, but their effect on the risk for CVD has been mixed based on previous cohort studies. Results from the Physicians’ Health Study II showed that multivitamins were ineffective in lowering the risk for major CVD events in male physicians aged at least 50 years.

Researchers analyzed data from 13,316 men (mean age, 64 years) who completed a semiquantitative food frequency questionnaire at baseline. Mean daily intake was then calculated for vegetables, fruits, whole grains, dairy products, nuts, and processed and red meats.

The following vitamin intakes were calculated: folate, vitamin B6, vitamin B12, vitamin C, vitamin D, magnesium and calcium. Researchers assessed dietary patterns using the Alternate Healthy Eating Index and the Alternate Mediterranean Diet.

Primary endpoints in the Physicians’ Health Study II included major CV events, defined as nonfatal stroke, nonfatal MI and CVD mortality. Total stroke and total MI were secondary endpoints in the original study, and researchers added CV death, ischemic stroke and total mortality for the present study. Patients were followed up for an average of 11.4 years (standard deviation, 2.3 years).

No interaction

Researchers did not find a significant interaction between the food groups that were reviewed and multivitamin use on the risk for total mortality and CVD mortality. Consistent patterns were not seen in most of patients’ nutrient intakes and dietary pattern (P > .05). Multivitamin use and B12 had “interaction effects” on CVD mortality (P for interaction = .04) and total mortality (P for interaction = .04), they wrote. A similar degree of interaction was seen in multivitamin use and vitamin D for CVD mortality (P for interaction = .03). Multivitamin use and vitamin B6 affected patients’ risk for MI (P for interaction = .01).

Howard D. Sesso, MD
Howard D. Sesso

“Given the continued high prevalence of multivitamin use in the U.S., it remains critical for us to understand its role on nutritional status and other long-term health outcomes through clinical trials such as [Physicians’ Health Study II] and other new research initiatives,” Howard D. Sesso, ScD, MPH, associate epidemiologist at Brigham and Women’s Hospital and associate professor of medicine at Harvard Medical School, said in a press release.

Unanswered questions

“In light of the generally poor population-wide adherence to the recommended U.S. dietary guidelines, including excessive intake of foods high in salt, sugar and saturated fat in place of fruits, vegetables and whole grains, a multivitamin-mineral supplement might seem to offer ‘insurance’ against the potential chronic disease consequences,” Linda Van Horn, PhD, RD, associate dean for faculty development and professor of preventive medicine (nutrition) at Northwestern University Feinberg School of Medicine, wrote in a related editorial.

“An intriguing but unanswered question is whether those who follow a healthy diet and meet dietary recommendations long term, especially beginning in early life and continuing throughout the age span, simply do not require supplements because the bioavailability of the food-based nutrients, phytochemicals, microbes and other beneficial dietary factors remain optimal, thereby negating any necessity of or further benefit from supplements,” Van Horn wrote. – by Darlene Dobkowski

Disclosure: Sesso reports receiving investigator-initiated grants from Pfizer. Van Horn reports no relevant financial disclosures. Please see the full study for the other researchers’ relevant financial disclosures.

Dietary intake did not affect the risk for heart disease in middle-aged and older men who were taking multivitamins, according to a study published in JAMA Cardiology.

Multivitamin supplements are taken by more than 50% of older adults in the United States, but their effect on the risk for CVD has been mixed based on previous cohort studies. Results from the Physicians’ Health Study II showed that multivitamins were ineffective in lowering the risk for major CVD events in male physicians aged at least 50 years.

Researchers analyzed data from 13,316 men (mean age, 64 years) who completed a semiquantitative food frequency questionnaire at baseline. Mean daily intake was then calculated for vegetables, fruits, whole grains, dairy products, nuts, and processed and red meats.

The following vitamin intakes were calculated: folate, vitamin B6, vitamin B12, vitamin C, vitamin D, magnesium and calcium. Researchers assessed dietary patterns using the Alternate Healthy Eating Index and the Alternate Mediterranean Diet.

Primary endpoints in the Physicians’ Health Study II included major CV events, defined as nonfatal stroke, nonfatal MI and CVD mortality. Total stroke and total MI were secondary endpoints in the original study, and researchers added CV death, ischemic stroke and total mortality for the present study. Patients were followed up for an average of 11.4 years (standard deviation, 2.3 years).

No interaction

Researchers did not find a significant interaction between the food groups that were reviewed and multivitamin use on the risk for total mortality and CVD mortality. Consistent patterns were not seen in most of patients’ nutrient intakes and dietary pattern (P > .05). Multivitamin use and B12 had “interaction effects” on CVD mortality (P for interaction = .04) and total mortality (P for interaction = .04), they wrote. A similar degree of interaction was seen in multivitamin use and vitamin D for CVD mortality (P for interaction = .03). Multivitamin use and vitamin B6 affected patients’ risk for MI (P for interaction = .01).

Howard D. Sesso, MD
Howard D. Sesso

“Given the continued high prevalence of multivitamin use in the U.S., it remains critical for us to understand its role on nutritional status and other long-term health outcomes through clinical trials such as [Physicians’ Health Study II] and other new research initiatives,” Howard D. Sesso, ScD, MPH, associate epidemiologist at Brigham and Women’s Hospital and associate professor of medicine at Harvard Medical School, said in a press release.

Unanswered questions

“In light of the generally poor population-wide adherence to the recommended U.S. dietary guidelines, including excessive intake of foods high in salt, sugar and saturated fat in place of fruits, vegetables and whole grains, a multivitamin-mineral supplement might seem to offer ‘insurance’ against the potential chronic disease consequences,” Linda Van Horn, PhD, RD, associate dean for faculty development and professor of preventive medicine (nutrition) at Northwestern University Feinberg School of Medicine, wrote in a related editorial.

“An intriguing but unanswered question is whether those who follow a healthy diet and meet dietary recommendations long term, especially beginning in early life and continuing throughout the age span, simply do not require supplements because the bioavailability of the food-based nutrients, phytochemicals, microbes and other beneficial dietary factors remain optimal, thereby negating any necessity of or further benefit from supplements,” Van Horn wrote. – by Darlene Dobkowski

Disclosure: Sesso reports receiving investigator-initiated grants from Pfizer. Van Horn reports no relevant financial disclosures. Please see the full study for the other researchers’ relevant financial disclosures.