CVD prevention: nutritional supplements continue to lose their luster

  • Ann Intern Med

  • International Clinical Digest
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Takeaway

  • In a sweeping overview of meta-analyses of the effect of supplements on cardiovascular disease (CVD) risk, the authors report that most supplements do little to mitigate CVD risk.
  • Vitamin D supplementation, especially combined with calcium, was linked to increased stroke risk.

Why this matters

  • Major studies have found little to no benefits associated with vitamin D , fish oil , or omega 3 supplementation.
  • Editorial: The title reflects the perspective: “Dispense With Supplements for Improving Heart Outcomes.”
  • Editorial says it is reasonable to avoid supplement or diet modifications in guidelines/recommendations pending better evidence.

Key results

  • With moderate certainty, risk ratios for CVD (95% CIs) with reduced salt were:
    • All-cause mortality (normotensive patients): 0.90 (0.85-0.95).
    • Cardiovascular mortality with hypertension: 0.67 (0.46-0.99).
  • Of very-low–moderate certainty evidence: 
    • Polyunsaturated fatty acids (PUFAs), myocardial infarction: 0.92 (0.85-0.99);
    • PUFAs, coronary heart disease: 0.93 (0.89-0.98);
    • Folic acid, stroke: 0.80 (0.67-0.96); and
    • Vitamin D plus calcium, stroke: 1.17 (1.05-1.30).
  • No associations of vitamin B6, multivitamins, vitamin A, selenium, dietary intervention (e.g., low-fat diet), iron, antioxidants with any outcomes.
  • Very low study heterogeneity.

Study design

  • Umbrella review, evidence map, 105 meta-analyses evaluating 24 interventions (16 supplement types, 8 diets).
  • Funding: No primary funding source.

Limitations

  • Some poor-quality studies, evidence.

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