Multivitamins & Prevention Part 1: Heart Disease

Alvin B. Lin, MD, FAAFP
 
Dr. Lin is an associate professor of family and community medicine at University of Nevada School of Medicine and an adjunct professor of family medicine and geriatrics at Touro University Nevada College of Medicine. He also serves as an advisory medical director for Infinity Hospice Care and as medical director of Lions HealthFirst Foundation. Dr. Lin maintains a small private practice in Las Vegas, NV. The posts represent the views of Dr. Lin, and in no way are to be construed as representative of the above listed organizations. Dr. Lin blogs about current medical literature and news at http://alvinblin.blogspot.com/.

In a randomized, double-blind, placebo-controlled trial to be published tomorrow in JAMA, the authors concluded that taking a multivitamin supplement daily for over a decade did not reduce the risk of heart disease in older men. The authors arrived at their conclusions by analyzing data from 14,641 male physicians, average age 64yo, of whom 754 had a history of heart disease. These men were simply randomized to either a multivitamin (Centrum Silver) or a placebo to be taken daily and followed for up to 11+yrs. Regardless of baseline heart disease status, taking a multivitamin did not affect heart disease event risk, much less stroke and death.

But the manufacturers would have you question whether the multivitamin was really given a chance to prove its effectiveness in a group of otherwise healthy men, over half of whom had never smoked and close to 40% had quit. Furthermore, close to two-thirds exercised at least once weekly (although this clearly isn't enough to meet current recommendations for physical activity). And most ate at least four servings/day of fruits & vegetables plus one serving/day of whole grains.   

Four out of five drank at least one alcohol drink a month while three out of four took a daily aspirin. Amazingly enough, close to three out of five did not have high blood pressure, almost two out of three did not have high cholesterol, and over 90% did not have diabetes. Clearly, these physician participants do not reflect the population at large. Which doesn't answer the question, what should you do? Well, if you practice a healthy lifestyle (and you know what that is!), it appears you don't have much to gain by taking a daily multivitamin in terms of preventing heart disease. But what about cancer? We'll discuss this tomorrow . . .