Credits Earned (2024) Crédits obtenus

Redeem Prepaid Membership

Tools for Practice Outils pour la pratique

#87 Daily multivitamins to reduce mortality, cardiovascular disease, and cancer

Does daily multivitamin supplementation reduce mortality, cardiovascular disease (CVD), and/or cancer?

Present evidence does not support the routine use of multivitamins to reduce mortality, cardiovascular disease, or cancer for people in developed countries.

CFPCLearn Logo

Reading Tools for Practice Article can earn you MainPro+ Credits

La lecture d'articles d'outils de pratique peut vous permettre de gagner des crédits MainPro+

Join Now S’inscrire maintenant

Already a CFPCLearn Member? Log in

Déjà abonné à CMFCApprendre? Ouvrir une session

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.
Physicians’ Health Study II: Heavily publicized RCT2,3 of 14,641 men (mean age 64.3) randomized to Centrum Silver™ or placebo, followed 11.2 years.
  • 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
Derniers outils pour la pratique

#367 Oral Calcitonin Gene-related Peptide Antagonists: A painfully long name for the acute treatment of migraines

What are the risks and benefits of ubrogepant for the acute treatment of episodic migraines?
Read Lire 0.25 credits available Crédits disponibles

#366 Looking for Closure: Managing simple excisions or wounds efficiently

What are some options for efficiency in wound closure?
Read Lire 0.25 credits available Crédits disponibles

#365 Shrooms for Glooms: Evidence for psilocybin for depression

What are the benefits and harms of psilocybin for treatment-resistant/recurrent depression?
Read Lire 0.25 credits available Crédits disponibles

This content is certified for MainPro+ Credits, log in to access

Ce contenu est certifié pour les crédits MainPro+, Ouvrir une session

  • G. Michael Allan MD CCFP
  • Mayank Singal MD CCFP

1. Macpherson H, Pipingas A, Pase MP. Am J Clin Nutr. 2012 Dec 19. [Epub ahead of print]

2. Gaziano JM, Sesso HD, Christen WG, et al. JAMA. 2012; 308:1871-80.

3. Sesso HD, Christen WG, Bubes V, et al. JAMA. 2012; 308:1751-60.

4. Neuhouser ML, Wassertheil-Smoller S, Thomson C, et al. Arch Intern Med. 2009; 169:294-304.

5. Park SY, Murphy SP, Wilkens LR, et al. Am J Epidemiol. 2011; 173:906-14.

6. Li K, Kaaks R, Linseisen J, et al. Eur J Nutr. 2012; 51:407-13.

7. Watkins ML, Erickson JD, Thun MJ, et al. Am J Epidemiol. 2000; 152:149-62.

8. Blot WJ, Li JY, Taylor PR, et al. J Natl Cancer Inst. 1993; 85:1483-92.

9. Clarke R, Halsey J, Lewington S, et al. Arch Intern Med. 2010; 170:1622-31.

10. Bjelakovic G, Nikolova D, Gluud LL, et al. Cochrane Database Syst Rev. 2012; 3:CD007176.

11. Bjelakovic G, Gluud LL, Nikolova D, et al. Cochrane Database Syst Rev. 2011; 7:CD007470.

Authors do not have any conflicts of interest to declare.

Les auteurs n’ont aucun conflit d’intérêts à déclarer.

Most recent review: 05/08/2016

By: Ricky D. Turgeon BSc(Pharm) ACPR PharmD


Evidence Updated: No new evidence; Bottom Line: No change.

Learning at a glance
Yearly credits
Acquired ()
Your content by topic
Cardiology Dermatology Emergency
My Bookmarks