Vitamin and Mineral Supplementation for the Prevention of CVD and Cancer: An Updated Report from the USPSTF
JAMA: The Journal of the American Medical Association: Published June 21, 2022
Cardiovascular disease and cancer are the 2 leading causes of death. Vitamin and mineral supplementation has been proposed as a preventive strategy for both diseases because of shared disease pathways involving oxidative stress, inflammation, and methionine metabolism.
Further, observational evidence has suggested associations between higher plasma levels of various vitamins and minerals and lower rates of cardiovascular disease and cancer.
This Updated Evidence Report and Systematic Review for the US Preventive Services Task Force (USPSTF) examined the use of vitamins and minerals for primary prevention of cardiovascular disease and cancer.
TAKE-HOME MESSAGE
This systematic review by the United States Preventive Services Task Force (USPSTF) provides updated evidence on the benefits and harms of vitamin and mineral supplementation to prevent cardiovascular disease (CVD) and cancer in healthy adults.
The prior USPSTF guidance recommended against beta-carotene and vitamin E supplementation for the prevention of CVD and cancer owing to insufficient evidence.
This update recommends against the use of most vitamin and mineral supplements, as there is no clinical evidence of a protective effect against CVD, cancer, or all-cause mortality in healthy adults aside from a very small benefit on cancer prevention with multivitamin supplementation.
Clinicians should not routinely recommend vitamin or mineral supplementation to prevent CVD and cancer, particularly in healthy adults without nutritional deficiencies.
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Importance
Cardiovascular disease and cancer are the 2 leading causes of death in the US, and vitamin and mineral supplementation has been proposed to help prevent these conditions.
Objective
To review the benefits and harms of vitamin and mineral supplementation in healthy adults to prevent cardiovascular disease and cancer to inform the US Preventive Services Task Force.
Data Sources
MEDLINE, PubMed (publisher-supplied records only), Cochrane Library, and Embase (January 2013 to February 1, 2022); prior reviews.
Study Selection
English-language randomized clinical trials (RCTs) of vitamin or mineral use among adults without cardiovascular disease or cancer and with no known vitamin or mineral deficiencies; observational cohort studies examining serious harms.
Data Extraction and Synthesis
Single extraction, verified by a second reviewer. Quantitative pooling methods appropriate for rare events were used for most analyses.
Main Outcomes and Measures
Mortality, cardiovascular disease events, cancer incidence, serious harms.
Results
Eighty-four studies (N=739 803) were included. In pooled analyses, multivitamin use was significantly associated with a lower incidence of any cancer and lung cancer. However, the evidence for multivitamins had important limitations. Beta carotene (with or without vitamin A) was significantly associated with an increased risk of lung cancer and cardiovascular mortality. Vitamin D use was not significantly associated with all-cause mortality, cardiovascular disease or cancer outcomes. Vitamin E was not significantly associated with all-cause mortality, cardiovascular disease events, or cancer incidence. Evidence for benefit of other supplements was equivocal, minimal, or absent. Limited evidence suggested some supplements may be associated with higher risk of serious harms (hip fracture [vitamin A], hemorrhagic stroke [vitamin E], and kidney stones [vitamin C, calcium]).
Conclusions and Relevance
Vitamin and mineral supplementation was associated with little or no benefit in preventing cancer, cardiovascular disease, and death, with the exception of a small benefit for cancer incidence with multivitamin use. Beta carotene was associated with an increased risk of lung cancer and other harmful outcomes in persons at high risk of lung cancer.
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