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Annals of Internal Medicine "Stop Wasting Money on Vitamins and Mineral Supplements"



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ChiroACCESS Editorial Staff

  

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December 19, 2013

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The December 2013 issue of Annals of Internal Medicine is in large part dedicated to negative studies and a criticism of vitamin and supplement use.  The accompanying editorial (http://annals.org/article.aspx?articleid=1789253) "Enough is enough: Stop Wasting Money on Vitamin and Mineral Supplements" summarizes the three current studies (see abstracts below).

The studies investigate the use of vitamins after myocardial infarction, long term use related to cognitive function in men, and primary prevention of cardiovascular disease and cancer.  The studies note limitations but suggest the use of vitamins and supplements may be ineffective for these three conditions.  

As evidenced by an article by ABC News Radio that states "Researchers looked at past findings and concluded that vitamins and mineral supplements are ineffective in the general population..." http://www.eastidahonews.com/2013/12/americans-spending-too-much-on-ineffective-vitamins-and-supplements/, the media is already overstating the implications of the research.

There is no question that some supplementation is unnecessary resulting in a waste of money and in very rare cases supplements such as Vitamin E and Vitamin A can be associated with adverse events.  However, the literature is clear that the problem with vitamins and other supplements pales in comparison with the unnecessary cost and adverse events associated with drugs and surgical procedures.

Note:  These mini-reviews are designed as updates and direct the reader to the full text of current research.  The abstracts presented here are no substitute for reading and critically reviewing the full text of the original research.  Where permitted we will direct the reader to that full text.

Oral High-Dose Multivitamins and Minerals After Myocardial Infarction: A Randomized Trial  [Link]

Ann Intern Med. 17 December 2013

Gervasio A. Lamas, MD; Robin Boineau, MD, MA; Christine Goertz, DC, PhD; Daniel B. Mark, MD, MPH; Yves Rosenberg, MD; Mario Stylianou, PhD; Theodore Rozema, MD; Richard L. Nahin, PhD, MPH; Lauren Lindblad, MS; Eldrin F. Lewis, MD; Jeanne Drisko, MD; Kerry L. Lee, PhD, for the TACT (Trial to Assess Chelation Therapy) Investigators*

Background: Whether high-dose multivitamins are effective for secondary prevention of atherosclerotic disease is unknown.

Objective: To assess whether oral multivitamins reduce cardiovascular events and are safe.

Design: Double-blind, placebo-controlled, 2 × 2 factorial, multicenter, randomized trial. (ClinicalTrials.gov: NCT00044213)

Setting: 134 U.S. and Canadian academic and clinical sites.

Patients: 1708 patients aged 50 years or older who had myocardial infarction (MI) at least 6 weeks earlier and had serum creatinine levels of 176.8 µmol/L (2.0 mg/dL) or less.

Intervention: Patients were randomly assigned to an oral, 28-component, high-dose multivitamin and multimineral mixture or placebo.

Measurements: The primary end point was time to total death, recurrent MI, stroke, coronary revascularization, or hospitalization for angina.

Results: The median age was 65 years, and 18% of patients were women. The qualifying MI occurred a median of 4.6 years (interquartile range [IQR], 1.6 to 9.2 years) before enrollment. Median follow-up was 55 months (IQR, 26 to 60 months). Patients received vitamins for a median of 31 months (IQR, 13 to 59 months) in the vitamin group and 35 months (IQR, 13 to 60 months) in the placebo group (P = 0.65). Totals of 645 (76%) and 646 (76%) patients in the vitamin and placebo groups, respectively, completed at least 1 year of oral therapy (P = 0.98), and 400 (47%) and 426 (50%) patients, respectively, completed at least 3 years (P = 0.23). Totals of 394 (46%) and 390 (46%) patients in the vitamin and placebo groups, respectively, discontinued the vitamin regimen (P = 0.67), and 17% of patients withdrew from the study. The primary end point occurred in 230 (27%) patients in the vitamin group and 253 (30%) in the placebo group (hazard ratio, 0.89 [95% CI, 0.75 to 1.07]; P = 0.21). No evidence suggested harm from vitamin therapy in any category of adverse events.

Limitation: There was considerable nonadherence and withdrawal, limiting the ability to draw firm conclusions (particularly about safety).

Conclusion: High-dose oral multivitamins and multiminerals did not statistically significantly reduce cardiovascular events in patients after MI who received standard medications. However, this conclusion is tempered by the nonadherence rate.


Vitamin and Mineral Supplements in the Primary Prevention of Cardiovascular Disease and Cancer: An Updated Systematic Evidence Review for the U.S. Preventive Services Task Force  [Link]

Ann Intern Med. 2013;159(12):824-834-834.

Stephen P. Fortmann, MD; Brittany U. Burda, MPH; Caitlyn A. Senger, MPH; Jennifer S. Lin, MD, MCR; and Evelyn P. Whitlock, MD, MPH

Background: Vitamin and mineral supplements are commonly used to prevent chronic diseases.

Purpose: To systematically review evidence for the benefit and harms of vitamin and mineral supplements in community-dwelling, nutrient-sufficient adults for the primary prevention of cardiovascular disease (CVD) and cancer.

Data Sources: MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Database of Abstracts of Reviews of Effects were searched from January 2005 to 29 January 2013, with manual searches of reference lists and gray literature.

Study Selection: Two investigators independently selected and reviewed fair- and good-quality trials for benefit and fair- and good-quality trials and observational studies for harms.

Data Extraction: Dual quality assessments and data abstraction.

Data Synthesis: Two large trials (n = 27 658) reported lower cancer incidence in men taking a multivitamin for more than 10 years (pooled unadjusted relative risk, 0.93 [95% CI, 0.87 to 0.99]). The study that included women showed no effect in that group. High-quality studies (k = 24; n = 324 653) of single and paired nutrients (such as vitamins A, C, or D; folic acid; selenium; or calcium) were scant and heterogeneous and showed no clear evidence of benefit or harm. Neither vitamin E nor ß-carotene prevented CVD or cancer, and ß-carotene increased lung cancer risk in smokers.

Limitations: The analysis included only primary prevention studies in adults without known nutritional deficiencies. Studies were conducted in older individuals and included various supplements and doses under the set upper tolerable limits. Duration of most studies was less than 10 years.

Conclusion: Limited evidence supports any benefit from vitamin and mineral supplementation for the prevention of cancer or CVD. Two trials found a small, borderline-significant benefit from multivitamin supplements on cancer in men only and no effect on CVD.

Primary Funding Source: Agency for Healthcare Research and Quality.


Long-Term Multivitamin Supplementation and Cognitive Function in Men: A Randomized Trial  [Link]

Ann Intern Med. 2013;159(12):806-814-814.

Francine Grodstein, ScD*; Jacqueline O’Brien, ScD*; Jae Hee Kang, ScD; Rimma Dushkes, PhD; Nancy R. Cook, ScD; Olivia Okereke, MD; JoAnn E. Manson, MD, DrPH; Robert J. Glynn, PhD; Julie E. Buring, ScD; J. Michael Gaziano, MD, MPH; and Howard D. Sesso, ScD, MPH

Background: Despite widespread use of multivitamin supplements, their effect on cognitive health—a critical issue with aging—remains inconclusive. To date, no long-term clinical trials have studied multivitamin use and cognitive decline in older persons.

Objective: To evaluate whether long-term multivitamin supplementation affects cognitive health in later life.

Design: Randomized, double-blind, placebo-controlled trial of a multivitamin from 1997 to 1 June 2011. The cognitive function substudy began in 1998. Up to 4 repeated cognitive assessments by telephone interview were completed over 12 years. (ClinicalTrials.gov: NCT00270647)

Setting: The Physicians’ Health Study II.

Patients: 5947 male physicians aged 65 years or older.

Intervention: Daily multivitamin or placebo.

Measurements: A global composite score averaging 5 tests of global cognition, verbal memory, and category fluency. The secondary end point was a verbal memory score combining 4 tests of verbal memory, which is a strong predictor of Alzheimer disease.

Results: No difference was found in mean cognitive change over time between the multivitamin and placebo groups or in the mean level of cognition at any of the 4 assessments. Specifically, for the global composite score, the mean difference in cognitive change over follow-up was -0.01 SU (95% CI, -0.04 to 0.02 SU) when treatment was compared with placebo. Similarly, cognitive performance did not differ between the multivitamin and placebo groups on the secondary outcome, verbal memory (mean difference in cognitive change over follow-up, -0.005 SU [CI, -0.04 to 0.03 SU]).

Limitation: Doses of vitamins may be too low or the population may be too well-nourished to benefit from a multivitamin.

Conclusion: In male physicians aged 65 years or older, long-term use of a daily multivitamin did not provide cognitive benefits.

Primary Funding Source: National Institutes of Health, BASF, Pfizer, and DSM Nutritional Products.


Oral High-Dose Multivitamins and Minerals After Myocardial Infarction: A Randomized Trial  [Link]

Ann Intern Med. 2013;159(12):797-805-805.

Gervasio A. Lamas, MD; Robin Boineau, MD, MA; Christine Goertz, DC, PhD; Daniel B. Mark, MD, MPH; Yves Rosenberg, MD; Mario Stylianou, PhD; Theodore Rozema, MD; Richard L. Nahin, PhD, MPH; Lauren Lindblad, MS; Eldrin F. Lewis, MD; Jeanne Drisko, MD; Kerry L. Lee, PhD, for the TACT (Trial to Assess Chelation Therapy) Investigators*

Background: Whether high-dose multivitamins are effective for secondary prevention of atherosclerotic disease is unknown.

Objective: To assess whether oral multivitamins reduce cardiovascular events and are safe.

Design: Double-blind, placebo-controlled, 2 × 2 factorial, multicenter, randomized trial. (ClinicalTrials.gov: NCT00044213)

Setting: 134 U.S. and Canadian academic and clinical sites.

Patients: 1708 patients aged 50 years or older who had myocardial infarction (MI) at least 6 weeks earlier and had serum creatinine levels of 176.8 µmol/L (2.0 mg/dL) or less.

Intervention: Patients were randomly assigned to an oral, 28-component, high-dose multivitamin and multimineral mixture or placebo.

Measurements: The primary end point was time to total death, recurrent MI, stroke, coronary revascularization, or hospitalization for angina.

Results: The median age was 65 years, and 18% of patients were women. The qualifying MI occurred a median of 4.6 years (interquartile range [IQR], 1.6 to 9.2 years) before enrollment. Median follow-up was 55 months (IQR, 26 to 60 months). Patients received vitamins for a median of 31 months (IQR, 13 to 59 months) in the vitamin group and 35 months (IQR, 13 to 60 months) in the placebo group (P = 0.65). Totals of 645 (76%) and 646 (76%) patients in the vitamin and placebo groups, respectively, completed at least 1 year of oral therapy (P = 0.98), and 400 (47%) and 426 (50%) patients, respectively, completed at least 3 years (P = 0.23). Totals of 394 (46%) and 390 (46%) patients in the vitamin and placebo groups, respectively, discontinued the vitamin regimen (P = 0.67), and 17% of patients withdrew from the study. The primary end point occurred in 230 (27%) patients in the vitamin group and 253 (30%) in the placebo group (hazard ratio, 0.89 [95% CI, 0.75 to 1.07]; P = 0.21). No evidence suggested harm from vitamin therapy in any category of adverse events.

Limitation: There was considerable nonadherence and withdrawal, limiting the ability to draw firm conclusions (particularly about safety).

Conclusion: High-dose oral multivitamins and multiminerals did not statistically significantly reduce cardiovascular events in patients after MI who received standard medications. However, this conclusion is tempered by the nonadherence rate.

Primary Funding Source: National Institutes of Health.
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