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Efficacy of vitamin and antioxidant supplements in prevention of cardiovascular disease: systematic review and meta-analysis of randomised controlled trials.
BMJ 2013; 346:f10BMJ

Abstract

OBJECTIVE

To assess the efficacy of vitamin and antioxidant supplements in the prevention of cardiovascular diseases.

DESIGN

Meta-analysis of randomised controlled trials.

DATA SOURCES AND STUDY SELECTION

PubMed, EMBASE, the Cochrane Library, Scopus, CINAHL, and ClinicalTrials.gov searched in June and November 2012. Two authors independently reviewed and selected eligible randomised controlled trials, based on predetermined selection criteria.

RESULTS

Out of 2240 articles retrieved from databases and relevant bibliographies, 50 randomised controlled trials with 294,478 participants (156,663 in intervention groups and 137,815 in control groups) were included in the final analyses. In a fixed effect meta-analysis of the 50 trials, supplementation with vitamins and antioxidants was not associated with reductions in the risk of major cardiovascular events (relative risk 1.00, 95% confidence interval 0.98 to 1.02; I(2)=42%). Overall, there was no beneficial effect of these supplements in the subgroup meta-analyses by type of prevention, type of vitamins and antioxidants, type of cardiovascular outcomes, study design, methodological quality, duration of treatment, funding source, provider of supplements, type of control, number of participants in each trial, and supplements given singly or in combination with other supplements. Among the subgroup meta-analyses by type of cardiovascular outcomes, vitamin and antioxidant supplementation was associated with a marginally increased risk of angina pectoris, while low dose vitamin B(6) supplementation was associated with a slightly decreased risk of major cardiovascular events. Those beneficial or harmful effects disappeared in subgroup meta-analysis of high quality randomised controlled trials within each category. Also, even though supplementation with vitamin B(6) was associated with a decreased risk of cardiovascular death in high quality trials, and vitamin E supplementation with a decreased risk of myocardial infarction, those beneficial effects were seen only in randomised controlled trials in which the supplements were supplied by the pharmaceutical industry.

CONCLUSION

There is no evidence to support the use of vitamin and antioxidant supplements for prevention of cardiovascular diseases.

Authors+Show Affiliations

Department of Family Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea. msk@ncc.re.krNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Meta-Analysis
Review
Systematic Review

Language

eng

PubMed ID

23335472

Citation

Myung, Seung-Kwon, et al. "Efficacy of Vitamin and Antioxidant Supplements in Prevention of Cardiovascular Disease: Systematic Review and Meta-analysis of Randomised Controlled Trials." BMJ (Clinical Research Ed.), vol. 346, 2013, pp. f10.
Myung SK, Ju W, Cho B, et al. Efficacy of vitamin and antioxidant supplements in prevention of cardiovascular disease: systematic review and meta-analysis of randomised controlled trials. BMJ. 2013;346:f10.
Myung, S. K., Ju, W., Cho, B., Oh, S. W., Park, S. M., Koo, B. K., & Park, B. J. (2013). Efficacy of vitamin and antioxidant supplements in prevention of cardiovascular disease: systematic review and meta-analysis of randomised controlled trials. BMJ (Clinical Research Ed.), 346, pp. f10. doi:10.1136/bmj.f10.
Myung SK, et al. Efficacy of Vitamin and Antioxidant Supplements in Prevention of Cardiovascular Disease: Systematic Review and Meta-analysis of Randomised Controlled Trials. BMJ. 2013 Jan 18;346:f10. PubMed PMID: 23335472.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Efficacy of vitamin and antioxidant supplements in prevention of cardiovascular disease: systematic review and meta-analysis of randomised controlled trials. AU - Myung,Seung-Kwon, AU - Ju,Woong, AU - Cho,Belong, AU - Oh,Seung-Won, AU - Park,Sang Min, AU - Koo,Bon-Kwon, AU - Park,Byung-Joo, AU - ,, Y1 - 2013/01/18/ PY - 2013/1/22/entrez PY - 2013/1/22/pubmed PY - 2013/3/26/medline SP - f10 EP - f10 JF - BMJ (Clinical research ed.) JO - BMJ VL - 346 N2 - OBJECTIVE: To assess the efficacy of vitamin and antioxidant supplements in the prevention of cardiovascular diseases. DESIGN: Meta-analysis of randomised controlled trials. DATA SOURCES AND STUDY SELECTION: PubMed, EMBASE, the Cochrane Library, Scopus, CINAHL, and ClinicalTrials.gov searched in June and November 2012. Two authors independently reviewed and selected eligible randomised controlled trials, based on predetermined selection criteria. RESULTS: Out of 2240 articles retrieved from databases and relevant bibliographies, 50 randomised controlled trials with 294,478 participants (156,663 in intervention groups and 137,815 in control groups) were included in the final analyses. In a fixed effect meta-analysis of the 50 trials, supplementation with vitamins and antioxidants was not associated with reductions in the risk of major cardiovascular events (relative risk 1.00, 95% confidence interval 0.98 to 1.02; I(2)=42%). Overall, there was no beneficial effect of these supplements in the subgroup meta-analyses by type of prevention, type of vitamins and antioxidants, type of cardiovascular outcomes, study design, methodological quality, duration of treatment, funding source, provider of supplements, type of control, number of participants in each trial, and supplements given singly or in combination with other supplements. Among the subgroup meta-analyses by type of cardiovascular outcomes, vitamin and antioxidant supplementation was associated with a marginally increased risk of angina pectoris, while low dose vitamin B(6) supplementation was associated with a slightly decreased risk of major cardiovascular events. Those beneficial or harmful effects disappeared in subgroup meta-analysis of high quality randomised controlled trials within each category. Also, even though supplementation with vitamin B(6) was associated with a decreased risk of cardiovascular death in high quality trials, and vitamin E supplementation with a decreased risk of myocardial infarction, those beneficial effects were seen only in randomised controlled trials in which the supplements were supplied by the pharmaceutical industry. CONCLUSION: There is no evidence to support the use of vitamin and antioxidant supplements for prevention of cardiovascular diseases. SN - 1756-1833 UR - https://www.unboundmedicine.com/medline/citation/23335472/Efficacy_of_vitamin_and_antioxidant_supplements_in_prevention_of_cardiovascular_disease:_systematic_review_and_meta_analysis_of_randomised_controlled_trials_ L2 - http://www.bmj.com/cgi/pmidlookup?view=long&pmid=23335472 DB - PRIME DP - Unbound Medicine ER -