USPSTF Issues Cautious Recommendations on Nutritional Supplement Use for Preventing Cardiovascular Disease

John Wong, MD

The US Preventive Services Task Force (USPSTF) has released new guidance outlining the organization’s stance on use of vitamin, mineral, and multivitamin supplements for prevention of cardiovascular disease.

Released on June 21, the new recommendation statement, which details stances on supplementation for prevention of cancer and cardiovascular disease, provides an updated to the organization’s 2014 statement and conclude current evidence is insufficient for assessing the benefits and harms of multivitamin supplements and single- or paired-nutrient supplements, other than beta carotene and vitamin E, for prevention cardiovascular disease, which have been associated with increased risk of cardiovascular mortality and hemorrhagic stroke, respectively.

“We all want ways to prevent heart disease, stroke, and cancer, so the Task Force again reviewed the evidence on whether taking vitamins and minerals helps prevent these diseases,” says Task Force member John Wong, MD, in a statement from the USPSTF. “Unfortunately, based on the existing evidence, the Task Force cannot recommend for or against the use of most vitamins and minerals and is calling for more research.”

The USPSTF underlines the importance and relevance of their most recent statement by highlighting the growing popularity of supplements in the US with data from the National Health and Nutrition Examination Survey, which indicates more than 50% of US adults reported consuming at least 1 dietary supplement in the prior 30 days and 31% reporting use of a multivitamin supplement in that same time period.

To assess for potential updates in the knowledge base surrounding mineral or vitamin supplementation since the 2014 recommendation statement was created, a systematic review of relevant data was performed. The systematic review was aimed at identifying randomized clinical trials of vitamin or mineral use among adults for cardiovascular disease or cancer and with no known vitamin or mineral deficiencies and observational cohort studies examining serious harms published in Medline, PubMed, Cochrane Library, and Embase databases from January 2013-February 2022. From this review, a total of 84 studies, with a population of 739,803 individuals, were identified for inclusion in pooled analyses.

In these analyses, multivitamin use was significantly associated with a lower incidence of any cancer (OR, 0.93 [95% CI, 0.87-0.99]; 4 RCTs [n=48,859]; ARD range among adequately powered trials, −0.2% to −1.2%) and lung cancer (OR, 0.75 [95% CI, 0.58-0.95]; 2 RCTs [n=36,052]; ARD, 0.2%), but authors pointed the evidence for multivitamins had limitations to consider. Results indicated vitamin D use was not significantly associated with all-cause mortality (OR, 0.96 [95% CI, 0.91-1.02]; 27 RCTs [n=117,082]), cardiovascular disease (OR, 1.00 [95% CI, 0.95-1.05]; 7 RCTs [n=74,925]), or cancer outcomes (OR, 0.98 [95% CI, 0.92-1.03]; 19 RCTs [n=86,899]). Additionally, results indicated vitamin E was not significantly associated with all-cause mortality (OR, 1.02 [95% CI, 0.97-1.07]; 9 RCTs [n=107,772]), cardiovascular disease events (OR, 0.96 [95% CI, 0.90-1.04]; 4 RCTs [n=62,136]), or cancer incidence (OR, 1.02 [95% CI, 0.98-1.08]; 5 RCTs [n=76,777]).

Authors determined the evidence for benefit of other supplements was determined to be equivocal, animal, or absent. When assessing risk of harms, limited evidence pointed to potential associations for vitamin A and increased risk of hip fracture, vitamin E and increased risk of hemorrhagic stroke, and vitamin C and calcium with increased risk of kidney stones.

In an editorial, a trio of clinicians from Northwestern Medicine outline the struggles clinicians face when patients overestimate the purported benefits of a vitamin or mineral supplement and the need for greater counseling on lifestyle risks among patients at risk of cardiovascular disease.

“Beyond wasted money, the focus on supplements might be viewed as a potentially harmful distraction. Rather than focusing money, time, and attention on supplements, it would be better to emphasize lower-risk, higher-benefit activities. Individual, public health, public policy, and civic efforts should focus on supporting people in regular preventive care, following a healthful diet, getting exercise, maintaining a healthy weight, and avoiding smoking,” wrote Jenny Jia, MD, MSc, Natalie A. Cameron, MD, and Jeffrey A. Linder, MD, MPH, in the editorial.

This recommendation statement, “Vitamin, Mineral, and Multivitamin Supplementation to Prevent Cardiovascular Disease and Cancer,” was published in JAMA.