Many of my patients take a multivitamin supplement and a lot take individual vitamins or supplements. When they ask me if I think they are worthwhile I invariably say no, not from a cardiovascular standpoint. If they ask me if they should take the vitamin/supplement I usually respond that there is no evidence of harm and they should take it if some other reputable (not a chiropractor or naturopath) physician has advised it for a particular reason.
Data from the Center for Disease Control has shown that use of dietary supplements has increased progressively over the last decade . The graph below shows that despite evidence of no benefit , about a third of Americans continue to take a multivitamin/multimineral (defined as having 3 or more components)
This has been proven over and over again in multiple trials in which a vitamin with proposed healthy antioxidant properties (say Vitamine E or C) or anti-inflammatory properties (say homocysteine) has gone up against placebo. The vitamin is no better than placebo.
Apparently, the message that these chemicals are beneficial from the vitamin/nutraceutical/supplement industry is so persuasive and pervasive that my patients will continue to pay for and take their chosen vitamin or multivitamin despite my advice. The patients most likely to persist in taking the useless pills have a suspicion of doctors, the pharmaceutical industry and are convinced that “natural” methods (totally unproven by any scientific techniques) are superior to medically approved methods for disease prevention.
Nail In The Coffin for Multivitamins
The latest nail in the coffin for vitamins in the prevention of cardiovascular disease was published by Sesso et al in JAMA late last year .
This study reported data from the large, long term Physicians’ Health Study II which was started in 1997 and ended in 2011. Over 14 thousand male physicians over the age of fifty were entered into the study. On a random basis half of them took a multivitamin and half took a placebo (thus the study was randomized and placebo-controlled). Neither the patients nor their doctors knew who was taking what (thus double blind).
The study investigators measured who had what is termed in cardiology research a major adverse cardiovascular event, known as MACE. A MACE would in this case would be a stroke, a heart attack or death from cardiovascular disease.
The results of this really well done, large, controlled trial show absolutely no benefit of multivitamins in reducing any cardiovascular outcome. Those taking multivitamins were just as likely as those taking a placebo to have heart attacks, strokes or to die from any cause.
In the interest of full disclosure an earlier publication from this same study also in JAMA showed a very slight , barely significant lowering of risk of cancer by multivitamin use. However, the significance of these findings, given multiple other negative studies , lack of any mortality benefit, and any specific cancer effect has been widely questioned. An accompanying editorial , I think, best summarizes the weakness of the study and the authors, very clearly do not recommend multivitamin usage for preventing cancer.