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Vitamin, Mineral, and Multivitamin Supplementation to Prevent Cardiovascular Disease and CancerUS Preventive Services Task Force Recommendation Statement

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Abstract

Importance  According to National Health and Nutrition Examination Survey data, 52% of surveyed US adults reported using at least 1 dietary supplement in the prior 30 days and 31% reported using a multivitamin-mineral supplement. The most commonly cited reason for using supplements is for overall health and wellness and to fill nutrient gaps in the diet. Cardiovascular disease and cancer are the 2 leading causes of death and combined account for approximately half of all deaths in the US annually. Inflammation and oxidative stress have been shown to have a role in both cardiovascular disease and cancer, and dietary supplements may have anti-inflammatory and antioxidative effects.

Objective  To update its 2014 recommendation, the US Preventive Services Task Force (USPSTF) commissioned a review of the evidence on the efficacy of supplementation with single nutrients, functionally related nutrient pairs, or multivitamins for reducing the risk of cardiovascular disease, cancer, and mortality in the general adult population, as well as the harms of supplementation.

Population  Community-dwelling, nonpregnant adults.

Evidence Assessment  The USPSTF concludes with moderate certainty that the harms of beta carotene supplementation outweigh the benefits for the prevention of cardiovascular disease or cancer. The USPSTF also concludes with moderate certainty that there is no net benefit of supplementation with vitamin E for the prevention of cardiovascular disease or cancer. The USPSTF concludes that the evidence is insufficient to determine the balance of benefits and harms of supplementation with multivitamins for the prevention of cardiovascular disease or cancer. Evidence is lacking and the balance of benefits and harms cannot be determined. The USPSTF concludes that the evidence is insufficient to determine the balance of benefits and harms of supplementation with single or paired nutrients (other than beta carotene and vitamin E) for the prevention of cardiovascular disease or cancer. Evidence is lacking and the balance of benefits and harms cannot be determined.

Recommendation  The USPSTF recommends against the use of beta carotene or vitamin E supplements for the prevention of cardiovascular disease or cancer. (D recommendation) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of the use of multivitamin supplements for the prevention of cardiovascular disease or cancer. (I statement) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of the use of single- or paired-nutrient supplements (other than beta carotene and vitamin E) for the prevention of cardiovascular disease or cancer. (I statement)

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Article Information

Corresponding Author: Carol M. Mangione, MD, MSPH, David Geffen School of Medicine, University of California, Los Angeles, 10940 Wilshire Blvd, Ste 700, Los Angeles, CA 90024 (chair@uspstf.net).

Accepted for Publication: May 12, 2022.

The US Preventive Services Task Force (USPSTF) members: Carol M. Mangione, MD, MSPH; Michael J. Barry, MD; Wanda K. Nicholson, MD, MPH, MBA; Michael Cabana, MD, MA, MPH; David Chelmow, MD; Tumaini Rucker Coker, MD, MBA; Esa M. Davis, MD, MPH; Katrina E. Donahue, MD, MPH; Chyke A. Doubeni, MD, MPH; Carlos Roberto Jaén, MD, PhD, MS; Martha Kubik, PhD, RN; Li Li, MD, PhD, MPH; Gbenga Ogedegbe, MD, MPH; Lori Pbert, PhD; John M. Ruiz, PhD; James Stevermer, MD, MSPH; John B. Wong, MD.

Affiliations of The US Preventive Services Task Force (USPSTF) members: University of California, Los Angeles (Mangione); Harvard Medical School, Boston, Massachusetts (Barry); University of North Carolina at Chapel Hill (Nicholson, Donahue); Albert Einstein College of Medicine, New York, New York (Cabana); Virginia Commonwealth University, Richmond (Chelmow); University of Washington, Seattle (Coker); University of Pittsburgh, Pittsburgh, Pennsylvania (Davis); Mayo Clinic, Rochester, Minnesota (Doubeni); The University of Texas Health Science Center, San Antonio (Jaén); George Mason University, Fairfax, Virginia (Kubik); University of Virginia, Charlottesville (Li); New York University, New York, New York (Ogedegbe); University of Massachusetts Medical School, Worcester (Pbert); University of Arizona, Tucson (Ruiz); University of Missouri, Columbia (Stevermer); Tufts University School of Medicine, Boston, Massachusetts (Wong).

Author Contributions: Dr Mangione had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. The USPSTF members contributed equally to the recommendation statement.

Conflict of Interest Disclosures: Authors followed the policy regarding conflicts of interest described at https://www.uspreventiveservicestaskforce.org/uspstf/about-uspstf/conflict-interest-disclosures. All members of the USPSTF receive travel reimbursement and an honorarium for participating in USPSTF meetings.

Funding/Support: The USPSTF is an independent, voluntary body. The US Congress mandates that the Agency for Healthcare Research and Quality (AHRQ) support the operations of the USPSTF.

Role of the Funder/Sponsor: AHRQ staff assisted in the following: development and review of the research plan, commission of the systematic evidence review from an Evidence-based Practice Center, coordination of expert review and public comment of the draft evidence report and draft recommendation statement, and the writing and preparation of the final recommendation statement and its submission for publication. AHRQ staff had no role in the approval of the final recommendation statement or the decision to submit for publication. Recommendations made by the USPSTF are independent of the US government. They should not be construed as an official position of AHRQ or the US Department of Health and Human Services.

Additional Contributions: We thank Howard Tracer, MD (AHRQ), who contributed to the writing of the manuscript, and Lisa Nicolella, MA (AHRQ), who assisted with coordination and editing.

Additional Information: The US Preventive Services Task Force (USPSTF) makes recommendations about the effectiveness of specific preventive care services for patients without obvious related signs or symptoms. It bases its recommendations on the evidence of both the benefits and harms of the service and an assessment of the balance. The USPSTF does not consider the costs of providing a service in this assessment. The USPSTF recognizes that clinical decisions involve more considerations than evidence alone. Clinicians should understand the evidence but individualize decision-making to the specific patient or situation. Similarly, the USPSTF notes that policy and coverage decisions involve considerations in addition to the evidence of clinical benefits and harms. Published by JAMA®—Journal of the American Medical Association under arrangement with the Agency for Healthcare Research and Quality (AHRQ). ©2022 AMA and United States Government, as represented by the Secretary of the Department of Health and Human Services (HHS), by assignment from the members of the United States Preventive Services Task Force (USPSTF). All rights reserved.

References
1.
Cowan  AE , Jun  S , Gahche  JJ ,  et al.  Dietary supplement use differs by socioeconomic and health-related characteristics among US adults, NHANES 2011-2014.   Nutrients. 2018;10(8):1114. doi:10.3390/nu10081114PubMedGoogle ScholarCrossref
2.
Murphy  SL , Xu  J , Kochanek  KD , Arias  E , Tejada-Vera  B .  Deaths: final data for 2018.   Natl Vital Stat Rep. 2021;69(13):1-83.PubMedGoogle Scholar
3.
US Preventive Services Task Force. US Preventive Services Task Force Procedure Manual. Published May 2021. Accessed May 3, 2022. https://uspreventiveservicestaskforce.org/uspstf/about-uspstf/methods-and-processes/procedure-manual
4.
US Preventive Services Task Force.  Folic acid supplementation for the prevention of neural tube defects: US Preventive Services Task Force recommendation statement.   JAMA. 2017;317(2):183-189. doi:10.1001/jama.2016.19438PubMedGoogle ScholarCrossref
5.
Fairfield  KM . Vitamin supplementation in disease prevention. Updated May 21, 2021. Accessed May 3, 2022. https://www.uptodate.com/contents/vitamin-supplementation-in-disease-prevention
6.
National Center for Complementary and Integrative Health, National Institutes of Health. Vitamins and minerals. Updated February 2018. Accessed May 3, 2022. https://www.nccih.nih.gov/health/vitamins
7.
Tsao  CW , Aday  AW , Almarzooq  ZI ,  et al.  Heart disease and stroke statistics—2022 update: a report from the American Heart Association.   Circulation. 2022;145(8):e153-e639. doi:10.1161/CIR.0000000000001052PubMedGoogle ScholarCrossref
8.
National Center for Health Statistics. National Health Interview Survey, 2018: Table A-1a: age-adjusted percentages (with standard errors) of selected circulatory diseases among adults aged 18 and over, by selected characteristics: United States, 2018. Centers for Disease Control and Prevention. Accessed May 3, 2022. https://ftp.cdc.gov/pub/Health_Statistics/NCHS/NHIS/SHS/2018_SHS_Table_A-1.pdf
9.
SEER Cancer Statistics Review, 1975-2018: Table 1.1: estimated new cancer cases and deaths for 2021: all races, by sex. National Cancer Institute. Accessed May 3, 2022. https://seer.cancer.gov/archive/csr/1975_2018/browse_csr.php?sectionSEL=1&pageSEL=sect_01_table.01
10.
Henley  SJ , Ward  EM , Scott  S ,  et al.  Annual report to the nation on the status of cancer, part I: national cancer statistics.   Cancer. 2020;126(10):2225-2249. doi:10.1002/cncr.32802PubMedGoogle ScholarCrossref
11.
Doubeni  CA , Simon  M , Krist  AH .  Addressing systemic racism through clinical preventive service recommendations from the US Preventive Services Task Force.   JAMA. 2021;325(7):627-628. doi:10.1001/jama.2020.26188PubMedGoogle ScholarCrossref
12.
Dickinson  A , Bonci  L , Boyon  N , Franco  JC .  Dietitians use and recommend dietary supplements: report of a survey.   Nutr J. 2012;11:14. doi:10.1186/1475-2891-11-14PubMedGoogle ScholarCrossref
13.
Dickinson  A , Boyon  N , Shao  A .  Physicians and nurses use and recommend dietary supplements: report of a survey.   Nutr J. 2009;8:29. doi:10.1186/1475-2891-8-29PubMedGoogle ScholarCrossref
14.
US Preventive Services Task Force.  Interventions for tobacco smoking cessation in adults, including pregnant persons: US Preventive Services Task Force recommendation statement.   JAMA. 2021;325(3):265-279. doi:10.1001/jama.2020.25019PubMedGoogle ScholarCrossref
15.
Siu  AL ; US Preventive Services Task Force.  Screening for high blood pressure in adults: US Preventive Services Task Force recommendation statement.   Ann Intern Med. 2015;163(10):778-786. doi:10.7326/M15-2223PubMedGoogle ScholarCrossref
16.
US Preventive Services Task Force.  Statin use for the primary prevention of cardiovascular disease in adults: US Preventive Services Task Force recommendation statement.   JAMA. 2016;316(19):1997-2007. doi:10.1001/jama.2016.15450PubMedGoogle ScholarCrossref
17.
US Preventive Services Task Force.  Aspirin use to prevent cardiovascular disease: US Preventive Services Task Force recommendation statement.   JAMA. 2022;327(16):1577-1584. doi:10.1001/jama.2022.4983 PubMedGoogle ScholarCrossref
18.
US Preventive Services Task Force.  Behavioral weight loss interventions to prevent obesity-related morbidity and mortality in adults: US Preventive Services Task Force recommendation statement.   JAMA. 2018;320(11):1163-1171. doi:10.1001/jama.2018.13022PubMedGoogle ScholarCrossref
19.
US Preventive Services Task Force.  Behavioral counseling interventions to promote a healthy diet and physical activity for cardiovascular disease prevention in adults with cardiovascular risk factors: US Preventive Services Task Force recommendation statement.   JAMA. 2020;324(20):2069-2075. doi:10.1001/jama.2020.21749PubMedGoogle ScholarCrossref
20.
US Preventive Services Task Force.  Medication use to reduce risk of breast cancer: US Preventive Services Task Force recommendation statement.   JAMA. 2019;322(9):857-867. doi:10.1001/jama.2019.11885PubMedGoogle ScholarCrossref
21.
US Preventive Services Task Force.  Behavioral counseling to prevent skin cancer: US Preventive Services Task Force recommendation statement.   JAMA. 2018;319(11):1134-1142. doi:10.1001/jama.2018.1623PubMedGoogle ScholarCrossref
22.
Siu  AL ; US Preventive Services Task Force.  Screening for breast cancer: US Preventive Services Task Force recommendation statement.   Ann Intern Med. 2016;164(4):279-296. doi:10.7326/M15-2886PubMedGoogle ScholarCrossref
23.
US Preventive Services Task Force.  Screening for cervical cancer: US Preventive Services Task Force recommendation statement.   JAMA. 2018;320(7):674-686. doi:10.1001/jama.2018.10897PubMedGoogle ScholarCrossref
24.
US Preventive Services Task Force.  Screening for colorectal cancer: US Preventive Services Task Force recommendation statement.   JAMA. 2016;315(23):2564-2575. doi:10.1001/jama.2016.5989PubMedGoogle ScholarCrossref
25.
US Preventive Services Task Force.  Screening for lung cancer: US Preventive Services Task Force recommendation statement.   JAMA. 2021;325(10):962-970. doi:10.1001/jama.2021.1117PubMedGoogle ScholarCrossref
26.
US Preventive Services Task Force.  Screening for prostate cancer: US Preventive Services Task Force recommendation statement.   JAMA. 2018;319(18):1901-1913. doi:10.1001/jama.2018.3710PubMedGoogle ScholarCrossref
27.
US Preventive Services Task Force.  Risk assessment, genetic counseling, and genetic testing for BRCA-related cancer: US Preventive Services Task Force recommendation statement.   JAMA. 2019;322(7):652-665. doi:10.1001/jama.2019.10987PubMedGoogle ScholarCrossref
28.
US Preventive Services Task Force.  Vitamin D, calcium, or combined supplementation for the primary prevention of fractures in community-dwelling adults: US Preventive Services Task Force recommendation statement.   JAMA. 2018;319(15):1592-1599. doi:10.1001/jama.2018.3185PubMedGoogle ScholarCrossref
29.
US Preventive Services Task Force.  Interventions to prevent falls in community-dwelling older adults: US Preventive Services Task Force recommendation statement.   JAMA. 2018;319(16):1696-1704. doi:10.1001/jama.2018.3097PubMedGoogle ScholarCrossref
30.
Moyer  VA ; US Preventive Services Task Force.  Vitamin, mineral, and multivitamin supplements for the primary prevention of cardiovascular disease and cancer: US Preventive services Task Force recommendation statement.   Ann Intern Med. 2014;160(8):558-564. doi:10.7326/M14-0198PubMedGoogle ScholarCrossref
31.
O’Connor  EA , Evans  CV , Ivlev  I ,  et al.  Vitamin, Mineral, and Multivitamin Supplements for the Primary Prevention of Cardiovascular Disease and Cancer: A Systematic Evidence Review for the US Preventive Services Task Force. Evidence Synthesis No. 209. Agency for Healthcare Research and Quality; 2022. AHRQ publication 21-05278-EF-1.
32.
O’Connor  EA , Evans  CV , Ivlev  I ,  et al.  Vitamin and mineral supplements for the primary prevention of cardiovascular disease and cancer: updated evidence report and systematic review for the US Preventive Services Task Force.   JAMA. Published June 21, 2022. doi:10.1001/jama.2021.15650Google Scholar
33.
Omenn  GS , Goodman  GE , Thornquist  MD ,  et al.  Effects of a combination of beta carotene and vitamin A on lung cancer and cardiovascular disease.   N Engl J Med. 1996;334(18):1150-1155. doi:10.1056/NEJM199605023341802PubMedGoogle ScholarCrossref
34.
Alpha-Tocopherol, Beta Carotene Cancer Prevention Study Group.  The effect of vitamin E and beta carotene on the incidence of lung cancer and other cancers in male smokers.   N Engl J Med. 1994;330(15):1029-1035. doi:10.1056/NEJM199404143301501PubMedGoogle ScholarCrossref
35.
Moon  TE , Levine  N , Cartmel  B ,  et al; Southwest Skin Cancer Prevention Study Group.  Effect of retinol in preventing squamous cell skin cancer in moderate-risk subjects: a randomized, double-blind, controlled trial.   Cancer Epidemiol Biomarkers Prev. 1997;6(11):949-956.PubMedGoogle Scholar
36.
Sesso  HD , Manson  JE , Aragaki  AK ,  et al; COSMOS Research Group.  Effect of cocoa flavanol supplementation for prevention of cardiovascular disease events: the COSMOS randomized clinical trial.   Am J Clin Nutr. Published online March 16, 2022. doi:10.1093/ajcn/nqac055PubMedGoogle ScholarCrossref
37.
Hercberg  S , Galan  P , Preziosi  P ,  et al.  The SU.VI.MAX study: a randomized, placebo-controlled trial of the health effects of antioxidant vitamins and minerals.   Arch Intern Med. 2004;164(21):2335-2342. doi:10.1001/archinte.164.21.2335PubMedGoogle ScholarCrossref
38.
Christen  WG , Gaziano  JM , Hennekens  CH .  Design of Physicians’ Health Study II—a randomized trial of beta-carotene, vitamins E and C, and multivitamins, in prevention of cancer, cardiovascular disease, and eye disease, and review of results of completed trials.   Ann Epidemiol. 2000;10(2):125-134. doi:10.1016/S1047-2797(99)00042-3PubMedGoogle ScholarCrossref
39.
Manson  JE , Cook  NR , Lee  IM ,  et al; VITAL Research Group.  Vitamin D supplements and prevention of cancer and cardiovascular disease.   N Engl J Med. 2019;380(1):33-44. doi:10.1056/NEJMoa1809944PubMedGoogle ScholarCrossref
40.
Neale  RE , Baxter  C , Romero  BD ,  et al.  The D-Health trial: a randomised controlled trial of the effect of vitamin D on mortality.   Lancet Diabetes Endocrinol. 2022;10(2):120-128. doi:10.1016/S2213-8587(21)00345-4PubMedGoogle ScholarCrossref
41.
van Wijngaarden  JP , Swart  KM , Enneman  AW ,  et al.  Effect of daily vitamin B-12 and folic acid supplementation on fracture incidence in elderly individuals with an elevated plasma homocysteine concentration: B-PROOF, a randomized controlled trial.   Am J Clin Nutr. 2014;100(6):1578-1586. doi:10.3945/ajcn.114.090043PubMedGoogle ScholarCrossref
42.
Cole  BF , Baron  JA , Sandler  RS ,  et al; Polyp Prevention Study Group.  Folic acid for the prevention of colorectal adenomas: a randomized clinical trial.   JAMA. 2007;297(21):2351-2359. doi:10.1001/jama.297.21.2351PubMedGoogle ScholarCrossref
43.
Wu  K , Platz  EA , Willett  WC ,  et al.  A randomized trial on folic acid supplementation and risk of recurrent colorectal adenoma.   Am J Clin Nutr. 2009;90(6):1623-1631. doi:10.3945/ajcn.2009.28319PubMedGoogle ScholarCrossref
44.
Salonen  JT , Nyyssönen  K , Salonen  R ,  et al.  Antioxidant Supplementation in Atherosclerosis Prevention (ASAP) study: a randomized trial of the effect of vitamins E and C on 3-year progression of carotid atherosclerosis.   J Intern Med. 2000;248(5):377-386. doi:10.1046/j.1365-2796.2000.00752.xPubMedGoogle ScholarCrossref
45.
Sesso  HD , Buring  JE , Christen  WG ,  et al.  Vitamins E and C in the prevention of cardiovascular disease in men: the Physicians’ Health Study II randomized controlled trial.   JAMA. 2008;300(18):2123-2133. doi:10.1001/jama.2008.600PubMedGoogle ScholarCrossref
46.
Gaziano  JM , Glynn  RJ , Christen  WG ,  et al.  Vitamins E and C in the prevention of prostate and total cancer in men: the Physicians’ Health Study II randomized controlled trial.   JAMA. 2009;301(1):52-62. doi:10.1001/jama.2008.862PubMedGoogle ScholarCrossref
47.
National Institutes of Health, Office of Dietary Supplements. Vitamin A and carotenoids: fact sheet for health professionals. Updated March 23, 2022. Accessed May 3, 2022. https://ods.od.nih.gov/factsheets/VitaminA-HealthProfessional/
48.
Feskanich  D , Singh  V , Willett  WC , Colditz  GA .  Vitamin A intake and hip fractures among postmenopausal women.   JAMA. 2002;287(1):47-54. doi:10.1001/jama.287.1.47PubMedGoogle ScholarCrossref
49.
Lim  LS , Harnack  LJ , Lazovich  D , Folsom  AR .  Vitamin A intake and the risk of hip fracture in postmenopausal women: the Iowa Women’s Health Study.   Osteoporos Int. 2004;15(7):552-559. doi:10.1007/s00198-003-1577-yPubMedGoogle ScholarCrossref
50.
Meyer  HE , Willett  WC , Fung  TT , Holvik  K , Feskanich  D .  Association of high intakes of vitamins B6 and B12 from food and supplements with risk of hip fracture among postmenopausal women in the Nurses’ Health Study.   JAMA Netw Open. 2019;2(5):e193591. doi:10.1001/jamanetworkopen.2019.3591PubMedGoogle ScholarCrossref
51.
US Department of Agriculture and US Department of Health and Human Services.  Dietary Guidelines for Americans, 2020-2025. 9th ed. US Department of Health and Human Services; 2020.
52.
American Heart Association. Vitamin supplements: hype or help for healthy eating. Reviewed February 1, 2014. Accessed May 3, 2022. https://www.heart.org/en/healthy-living/healthy-eating/eat-smart/nutrition-basics/vitamin-supplements-hype-or-help-for-healthy-eating
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