From Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Warwick Medical School, University of Warwick, Coventry, England, United Kingdom; Annals of Internal Medicine, American College of Physicians, Philadelphia, Pennsylvania; and Johns Hopkins School of Medicine, Baltimore, Maryland.
From Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Warwick Medical School, University of Warwick, Coventry, England, United Kingdom; Annals of Internal Medicine, American College of Physicians, Philadelphia, Pennsylvania; and Johns Hopkins School of Medicine, Baltimore, Maryland.Tags: Problem Solving Games AdultsTufts Research Paper NavigatorAs Critical Thinking Grade Boundaries OcrContrast Essay OutlineExample Essay About YourselfEssay On Discipline In ClassWriting Research Papers TurabianThree Levels Of Thought Critical Thinking
After a median follow-up of 4.6 years, there was no significant difference in recurrent cardiovascular events with multivitamins compared with placebo (hazard ratio, 0.89 [95% CI, 0.75 to 1.07]).
The trial was limited by high rates of nonadherence and dropouts.
This message is especially true for the general population with no clear evidence of micronutrient deficiencies, who represent most supplement users in the United States and in other countries (9). Antioxidants, folic acid, and B vitamins are harmful or ineffective for chronic disease prevention, and further large prevention trials are no longer justified.
Vitamin D supplementation, however, is an open area of investigation, particularly in deficient persons.
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The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities.Evidence is sufficient to advise against routine supplementation, and we should translate null and negative findings into action.The message is simple: Most supplements do not prevent chronic disease or death, their use is not justified, and they should be avoided.Other reviews and guidelines that have appraised the role of vitamin and mineral supplements in primary or secondary prevention of chronic disease have consistently found null results or possible harms (5, 6).Evidence involving tens of thousands of people randomly assigned in many clinical trials shows that β-carotene, vitamin E, and possibly high doses of vitamin A supplements increase mortality (6, 7) and that other antioxidants (6), folic acid and B vitamins (8), and multivitamin supplements (1, 5) have no clear benefit.The decline in use of β-carotene and vitamin E supplements followed reports of adverse outcomes in lung cancer and all-cause mortality, respectively.In contrast, sales of multivitamins and other supplements have not been affected by major studies with null results, and the U. supplement industry continues to grow, reaching billion in annual sales in 2010.This evidence, combined with biological considerations, suggests that any effect, either beneficial or harmful, is probably small.As we learned from voluminous trial data on vitamin E, however, clinical trials are not well-suited to identify very small effects, and future trials of multivitamins for chronic disease prevention in well-nourished populations are likely to be futile.Similar trends have been observed in the United Kingdom and in other European countries.The large body of accumulated evidence has important public health and clinical implications.