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There is still a lack of evidence that vitamins prevent CVD, cancer: USPSTF


There is not enough evidence to recommend or oppose taking most vitamin and mineral supplements to prevent heart disease, strokeAnd a new report by the United States Preventive Services Task Force (USPSTF) on Cancer concludes.

However, there are two vitamins (vitamin E and beta-carotene) recommended by the Task Force for the prevention of heart disease, stroke, and cancer.Evidence is that taking vitamin E has no benefit and beta-carotene may increase the risk of lung cancer in people who are already at risk, such as smokers and people with occupational exposure. Shows asbestosIt’s careful.

These are the main findings of the USPSTF Final Recommendation Statement on vitamin, mineral, and multivitamin supplementation to prevent cardiovascular disease and cancer.

The statement is Release In the June 21 issue of JAMA,along with Evidence report, editorialWhen Patient page..

“This is essentially the same recommendation made by the Task Force in 2014,” said Dr. Jungwon, MD, a USPSTF member who is a professor of medicine at Tufts University School of Medicine in Boston. | Medscape Cardiology..

“In the United States, we recognize that more than half of people take some vitamin supplements daily and 30% take a combination of vitamins and minerals. Are there any benefits in reducing risk? I wanted to revisit the evidence to see if it was the cause of cardiovascular disease or cancer, or an increased chance of longevity. “

“We reviewed a total of 84 studies and searched hard for evidence, but with the two exceptions of beta-carotene and vitamin E, we couldn’t find enough evidence to support whether or not to take vitamins. “He said. ..

There is evidence that beta-carotene has some harm, but Wong explained that the main reason for not recommending vitamin E is consistent evidence of no benefit.

“Evidence of some other vitamins is inconsistent, but there is more consistent evidence than no benefit of vitamin E,” he said.

Most of the new evidence since the last review in 2014 was primarily about vitamin D supplementation, but all despite the inclusion of 32 new randomized controlled trials and two cohort studies. Pooled estimates of causal mortality have confidence intervals of just over 1, and point estimates suggest very small benefits at best, the Task Force said.

“After reviewing 84 studies (including 78 randomized controlled trials) in more than 1 million patients, excluding beta-carotene and vitamin E, the development of cardiovascular disease and cancer, or all causes The effect of this on mortality. Therefore, I don’t know if people should take vitamins. Further research is needed, “Wong added.

Regarding the use of multivitamin supplements, Wong said the full body of evidence did not find the benefits of taking multivitamins for cardiovascular or cancer mortality. However, the incidence of cancer has decreased slightly.

However, he pointed out that all three studies that suggested a reduced incidence of cancer had problems with generalizability.

“The average follow-up period for the recently published COSMOS trial was only 3.6 years. This is not long enough for cancer prophylaxis. One of the other studies used only antioxidants and The third study was conducted only in the United States. Male doctors. Therefore, these restrictions on generalization potential limited confidence in making recommendations for multivitamins, “Wong explained. ..

However, he said the Task Force did not find any significant harm from taking multivitamins.

“High doses of vitamin A and vitamin D can be harmful, but the doses generally contained in multivitamin tablets are lower than these. However, the purpose of taking multivitamins is cancer or We did not find enough evidence to make recommendations when it comes to reducing the risk of cardiovascular disease. “

Asked what to say to all people currently taking multivitamins, Wong replied that he would advise them to talk to a trusted health care professional about their particular situation.

“Our statement has a very narrow focus. It is intended for non-pregnant adults residing in the community. This recommendation is for children, those who are pregnant or may become pregnant, chronic illnesses. Someone, in hospital, or known malnutrition. “

“Advantages that seem small”

and editorial With the release of the USPSTF statement, Jenny Zia, MD, Natalie Cameron, and Jeffrey Linder (all from Chicago’s Northwestern University of Fineberg School of Medicine) have included 52 additional studies in their current evidence base. Please note that The final USPSTF recommendation on this topic was published in 2014.

Editors point out that it is difficult to prove that there is no benefit in the case of multivitamins, but current evidence suggests that the potential benefits of multivitamins to reduce mortality may be small. Suggests that is high.

They show an example of a healthy 65-year-old woman with an estimated mortality risk of about 8% for 9 years, and taking multivitamins for 5-10 years can reduce the estimated mortality risk to 7.5%. Note that (odds ratio 0.94).

“In addition to showing a small potential benefit, this estimate is based on incomplete evidence, is inaccurate, and is very sensitive to how the data is interpreted and analyzed,” they said. say.

The editors recommend that lifestyle counseling to prevent chronic illness should continue to focus on evidence-based approaches such as a balanced diet rich in fruits and vegetables and physical activity.

However, they say that if the American industrialized food system does not prioritize health, a healthy diet can be a challenge, healthy foods tend to be more expensive, access issues and food. He adds that it leads to anxiety.

Editors suggest that it is better to emphasize low-risk, profitable activities such as exercising, maintaining a healthy weight, and avoiding smoking, rather than focusing money, time, and attention on supplements. I am. Healthy eating.

What are the possible benefits for the elderly?

Comments on USPSTF Statement | Medscape CardiologyJo Ann Manson, MD, director of preventive medicine at Brigham and Women’s Hospital in Boston, who led the recent COSMOS study, said vitamin and mineral supplements should not be considered a healthy diet replacement.

“We need to focus on getting nutrition from plant-based foods that don’t strip vitamins and minerals by over-processing and a healthy diet high in whole foods,” she said. “It’s easier to take a pill every day than to focus on a healthy eating pattern, but the mixture of phytochemicals, fiber, and all other nutrients found in real foods can’t be packaged in a pill. Also, vitamins and minerals are better absorbed from food than supplements, and healthy foods can replace the calories of unhealthy foods such as lean meats and processed foods. “

However, Manson said there is increasing evidence that taking tablets containing moderate amounts of vitamins and minerals is safe and may actually benefit some people.

She noted that COSMOS and COSMOS-Mind studies have shown the benefits of multivitamins that slow cognitive decline in the elderly, but the findings need to be reproduced.

“In the USPSTF, a meta-analysis of four randomized trials showed a statistically significant 7% reduction in cancer due to multivitamins and a 6% reduction at the borderline mortality from all causes. “She said. “In addition, multivitamins have been shown to be very safe in some large, long-term randomized trials. I would like to make a comprehensive recommendation to anyone taking multivitamins. Agrees that the evidence is not sufficient, but there is increasing evidence that this is wise, an approach for many older people. “

“Many people see multivitamins as a form of insurance and as a way to hedge their bets,” she added. “This is a rational approach, but especially for those who are concerned about dietary adequacy, this idea is a healthy lifestyle, such as a healthy diet, regular physical activity, and not smoking. It is important not to bring self-satisfaction to following the practice. Blood pressure and cholesterol levels are well controlled and very important for health, but there are many other habits that are more difficult than taking pills daily. “

JAMA.. 2022; 327: 2326-2333, 2334-2347, 2294-2295, 2364. statement, Evidence report, editorial, Patient page




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