#87 Daily multivitamins to reduce mortality, cardiovascular disease, and cancer
CLINICAL QUESTION
Does daily multivitamin supplementation reduce mortality, cardiovascular disease (CVD), and/or cancer?
BOTTOM LINE
Present evidence does not support the routine use of multivitamins to reduce mortality, cardiovascular disease, or cancer for people in developed countries.
Reading Tools for Practice Article can earn you MainPro+ Credits
Join NowAlready a CFPCLearn Member? Log in
EVIDENCE
A meta-analysis and one Randomized Controlled Trial (RCT).
Meta-analysis1 of 21 RCTs (including RCT below) with 91,074 patients (54% males) randomized to multivitamins or placebo for 3.5 years. Most are primary prevention studies from Europe or North America
- No effect on overall mortality: Relative Risk (RR)=0.98 (0.94-1.02).
- No effect on cancer mortality: RR=0.96 (0.88-1.04).
- No effect on CVD mortality: RR=1.01 (0.93-1.09).
- Multiple subgroup testing found no differences.
- No evidence of publication bias or meaningful heterogeneity.
- No effect on overall mortality: Hazard Ratio (HR)=0.94 (0.88-1.02).
- No effect on cancer mortality: HR=0.88 (0.77-1.01).
- No effect on CVD mortality: HR=0.95 (0.83-1.09).
- No effect on CVD events: HR=1.01 (0.91-1.10).
- Reduced cancer incidence: HR=0.92 (0.86-0.998).
- These were adjusted (for unclear reasons).
- Unadjusted is not significant RR=0.94 (0.87-1.003).
- Multiple issues: Lots of exclusion including run-in to remove non-compliant patients, adjustments (without clear reason) always in favor of multivitamins.
- Multiple cohort studies have found no mortality reduction with multivitamins.
- Vitamin supplementation may help reduce overall mortality in undernourished populations (like rural China). 8
- However, in this RCT8 of four different vitamin interventions, only one reduced mortality RR=0.91 (0.84-0.99).
- Meta-analyses of different vitamin components on mortality:
- B-Vitamins:9 No effect.
- Anti-oxidants:10 Increase mortality RR=1.04 (1.01-1.07).
- Increase with vitamin E, beta-carotene and high-dose vitamin A.
- No effect from vitamin C and selenium.
- Vitamin D:11 Decrease mortality RR=0.97 (0.94-1.00)
- Increases and decreases are small [Numbers Needed to Harm (NNH) or treat around 200 over five years].
Latest Tools for Practice
#370 Antibiotics or no antibiotics for acute diverticulitis, that is the question!
Do antibiotics change clinical outcomes for patients with acute uncomplicated diverticulitis?
#369 Remind me, do medications that target brain amyloid improve my dementia?
Are amyloid-targeting monoclonal antibodies safe and effective for mild cognitive impairment or Alzheimer’s dementia?
#368 Sodium Restriction in Heart Failure: Beneficial or pouring salt in the wound?
Does sodium restriction improve outcomes in patients with chronic heart failure?
