Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Current Cardiology Reports
Published in: Current Cardiology Reports 4/2020

01-04-2020 | Stroke | Ischemic Heart Disease (D Mukherjee, Section Editor)

Supplemental Vitamins and Minerals for Cardiovascular Disease Prevention and Treatment

Authors: David Perez Ingles, Jose B. Cruz Rodriguez, Hernando Garcia

Published in: Current Cardiology Reports | Issue 4/2020

Login to get access

Abstract

Purpose of Review

The objective of this study is to explore the current literature supporting the use oral multivitamins and multi/minerals (OMVMs) for cardiovascular diseases (CVD) treatment and prevention.

Recent Findings

Data on multivitamins, vitamin C and D, coenzyme Q, calcium, and selenium, has showed no consistent benefit for the prevention of CVD, myocardial infarction, or stroke, nor was there a benefit for all-cause mortality to support their routine supplementation. Folic acid alone and B vitamins with folic acid, B6 and B12, reduce stroke, whereas niacin and antioxidants are associated with an increased risk of all-cause mortality. Iron deficiency should be avoided and treated if found, but routine supplementation to those without deficiency is not evidence based.

Summary

Despite the high supplement use by the general public, there is no evidence to support the routine supplementation of oral multivitamins and multi/minerals (OVMN) for CVD prevention or treatment.
Literature
1.
Roth GA, Abate D, Abate KH, Abay SM, Abbafati C, Abbasi N, et al. Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018;392(10159):1736–88.CrossRef
2.
3.
4.
Skeie G, Braaten T, Hjartåker A, Lentjes M, Amiano P, Jakszyn P, et al. Use of dietary supplements in the European prospective investigation into cancer and nutrition calibration study. Eur J Clin Nutr. 2009;63(S4):S226.CrossRefPubMed
5.
• Jenkins DJ, Spence JD, Giovannucci EL, Kim YI, Josse R, Vieth R, et al. Supplemental vitamins and minerals for CVD prevention and treatment. J Am Coll Cardiol. 2018;71(22):2570–84 Conclusive evidence for the benefit of any supplement across all dietary backgrounds (including deficiency and sufficiency) was not demonstrated.CrossRefPubMed
6.
7.
8.
Steinberg D, Witztum JL. Is the oxidative modification hypothesis relevant to human atherosclerosis? Do the antioxidant trials conducted to date refute the hypothesis? Circulation. 2002;105:2107–11.CrossRefPubMed
9.
Stephens NG, Parsons A, Brown MJ, Schofield PM, Kelly F, Cheeseman K, et al. Randomised controlled trial of vitamin E in patients with coronary disease: Cambridge Heart Antioxidant Study (CHAOS). Lancet. 1996;347(9004):781–6.CrossRefPubMed
10.
Moyer VA. 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):558–64.CrossRefPubMed
11.
12.
Csepanyi E, Czompa A, Haines D, Lekli I, Bakondi E, Balla G, et al. Cardiovascular effects of low versus high-dose beta-carotene in a rat model. Pharmacol Res. 2015;100:148–56.CrossRefPubMed
13.
14.
15.
16.
Schwingshackl L, Boeing H, Stelmach-Mardas M, Gottschald M, Dietrich S, Hoffmann G, et al. Dietary supplements and risk of cause-specific death, cardiovascular disease, and cancer: a systematic review and meta-analysis of primary prevention trials. Adv Nutr. 2017;8(1):27–39.CrossRefPubMedPubMedCentral
17.
Zhao LG, Zhang QL, Zheng JL, Li HL, Zhang W, Tang WG, et al. Dietary, circulating beta-carotene and risk of all-cause mortality: a meta-analysis from prospective studies. Sci Rep. 2016;6:26983.CrossRefPubMedPubMedCentral
18.
Omenn GS, Goodman GE, Thornquist MD, Balmes J, Cullen MR, Glass A, 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):1150–5.CrossRefPubMed
19.
20.
Bleys J, Miller ER III, Pastor-Barriuso R, Appel LJ, Guallar E. Vitamin-mineral supplementation and the progression of atherosclerosis: a meta-analysis of randomized controlled trials. Am J Clin Nutr. 2006;84(4):880–7.CrossRefPubMed
21.
• Christen WG, Cook NR, Van Denburgh M, Zaharris E, Albert CM, Manson JE. Effect of combined treatment with folic acid, vitamin B6, and vitamin B12 on plasma biomarkers of inflammation and endothelial dysfunction in women. J Am Heart Assoc. 2018;7(11):e008517. https://​doi.​org/​10.​1161/​JAHA.​117.​008517Long-term, combined treatment with folic acid, vitamin B6, and vitamin B12 lowers homocysteine concentrations, but does not alter major biomarkers of vascular inflammation, consistent with the lack of clinical cardiovascular disease benefit in the trial.CrossRefPubMedPubMedCentral
22.
23.
Bønaa KH, Njølstad I, Ueland PM, Schirmer H, Tverdal A, Steigen T, et al. Homocysteine lowering and cardiovascular events after acute myocardial infarction. N Engl J Med. 2006;354(15):1578–88.CrossRefPubMed
24.
Heart Outcomes Prevention Evaluation (HOPE) 2 Investigators. Homocysteine lowering with folic acid and B vitamins in vascular disease. N Engl J Med. 2006;354(15):1567–77.CrossRef
25.
Huo Y, Li J, Qin X, Huang Y, Wang X, Gottesman RF, et al. Efficacy of folic acid therapy in primary prevention of stroke among adults with hypertension in China: the CSPPT randomized clinical trial. JAMA. 2015;313:1325–35.CrossRefPubMed
26.
Spence JD. Metabolic vitamin B12 deficiency: a missed opportunity to prevent dementia and stroke. Nutr Res. 2016;36:109–16.CrossRefPubMed
27.
Garg A, Sharma A, Krishnamoorthy P, Garg J, Virmani D, Sharma T, et al. Role of niacin in current clinical practice: a systematic review. Am J Med. 2017;130(2):173–87.CrossRefPubMed
28.
HPS2-THRIVE Collaborative Group. Effects of extended-release niacin with laropiprant in high risk patients. N Engl J Med. 2014;371:203–12.CrossRef
29.
Anderson TJ, Boden WE, Desvigne-Nickens P, Fleg JL, Kashyap ML, McBride R, et al. Safety profile of extended-release niacin in the AIM-HIGH trial. N Engl J Med. 2014;371:288–90.CrossRefPubMedPubMedCentral
30.
Lee D, Folsom A, Harnack L, Halliwell B, Jacobs D. Does supplemental vitamin C increase cardiovascular disease risk in women with diabetes? Am Am J Clin Nutr. 2004;80:1194–200.CrossRefPubMed
31.
Martín-Calvo N, Martínez-González M. Vitamin C intake is inversely associated with cardiovascular mortality in a cohort of Spanish graduates: the SUN project. Nutrients. 2017;9(9):954.CrossRefPubMedCentral
32.
Ashor AW, Lara J, Mathers JC, Siervo M. Effect of vitamin C on endothelial function in health and disease: a systematic review and meta-analysis of randomised controlled trials. Atherosclerosis. 2014;235(1):9–20.CrossRefPubMed
33.
Juraschek S, Guallar E, Appel L, Miller E. Effects of vitamin C supplementation on blood pressure: a meta-analysis of randomized controlled trials. Am J Clin Nutr. 2012;95:1079–88.CrossRefPubMedPubMedCentral
34.
Al-Khudairy L, Flowers N, Wheelhouse R, Ghannam O, Hartley L, Stranges S, et al. Vitamin C supplementation for the primary prevention of cardiovascular disease. Cochrane Database Syst Rev. 2017;3.
35.
Melamed ML, Michos ED, Post W, Astor B. 25-hydroxyvitamin D levels and the risk of mortality in the general population. Arch Intern Med. 2008;168:1629–37.CrossRefPubMedPubMedCentral
36.
37.
Beveridge LA, Khan F, Struthers AD, Armitage J, Barchetta I, Bressendorff I, et al. Effect of vitamin D supplementation on markers of vascular function: a systematic review and individual participant meta-analysis. J Am Heart Assoc. 2018;7(11):e008273.CrossRefPubMedPubMedCentral
38.
Hsia J, Heiss G, Ren H, Allison M, Dolan NC, Greenland P, et al. Calcium/vitamin D supplementation and cardiovascular events. Circulation. 2007;115(7):846–54.CrossRefPubMed
39.
Zittermann A, Ernst JB, Prokop S, Fuchs U, Gruszka A, Dreier J, et al. Vitamin D supplementation of 4000 IU daily and cardiac function in patients with advanced heart failure: the EVITA trial. Int J Cardiol. 2019;280:117–23.CrossRefPubMed
40.
Zhang R, Li B, Gao X, Tian R, Pan Y, Jiang Y, et al. Serum 25-hydroxyvitamin D and the risk of cardiovascular disease: dose-response meta-analysis of prospective studies. Am J Clin Nutr. 2017;105(4):810–9.CrossRefPubMed
41.
Manson JE, Cook NR, Lee IM, Christen W, Bassuk SS, Mora S, et al. Vitamin D supplements and prevention of cancer and cardiovascular disease. N Engl J Med. 2019;380(1):33–44.CrossRefPubMed
42.
Zittermann A, Pilz S. Vitamin D and cardiovascular disease: an update. Anticancer Res. 2019;39(9):4627–35.CrossRefPubMed
43.
Chin K, Appel LJ, Michos ED. Vitamin D, calcium, and cardiovascular disease: a “D” vantageous or “D” etrimental? An era of uncertainty. Curr Atheroscler Rep. 2017;19(1):5.CrossRefPubMedPubMedCentral
44.
45.
46.
Rapola JM, Virtamo J, Ripatti S, Huttunen JK, Albanes D, Taylor PR, et al. Randomised trial of α-tocopherol and β-carotene supplements on incidence of major coronary events in men with previous myocardial infarction. Lancet. 1997;349(9067):1715–20.CrossRefPubMed
47.
48.
49.
Stonehouse W, et al. Short term effects of palm-tocotrienol and palm-carotenes on vascular function and cardiovascular disease risk: a randomised controlled trial. Atherosclerosis. 2016;254:205–14.CrossRefPubMed
50.
51.
52.
53.
Ohsaki Y, Shirakawa H, Miura A, Giriwono PE, Sato S, Ohashi A, et al. Vitamin K suppresses the lipopolysaccharide-induced expression of inflammatory cytokines in cultured macrophage-like cells via the inhibition of the activation of nuclear factor κB through the repression of IKKα/β phosphorylation. J Nutr Biochem. 2010;21:1120–6. https://​doi.​org/​10.​1016/​j.​jnutbio.​2009.​09.​011.CrossRefPubMed
54.
55.
56.
Madhavan MV, Tarigopula M, Mintz GS, Maehara A, Stone GW, Généreux P. Coronary artery calcification: pathogenesis and prognostic implications. J Am Coll Cardiol. 2014;63:1703–14.CrossRefPubMed
57.
58.
Dalmeijer GW, van der Schouw YT, Magdeleyns E, Ahmed N, Vermeer C, Beulens JWJ. The effect of menaquinone-7 supplementation on circulating species of matrix Gla protein. Atherosclerosis. 2012;225:397–402.CrossRefPubMed
59.
60.
61.
Reid IR, Mason B, Horne A, Ames R, Clearwater J, Bava U, et al. Effects of calcium supplementation on serum lipid concentrations in normal older women: a randomized controlled trial. Am J Med. 2002;112:343–7.CrossRefPubMed
62.
Reid IR, Horne A, Mason B, Ames R, Bava U, Gamble GD. Effects of calcium supplementation on body weight and blood pressure in normal older women: a randomized controlled trial. J Clin Endocrinol Metab. 2005;90:3824–9.CrossRefPubMed
63.
Goodman WG, Goldin J, Kuizon BD, Yoon C, Gales B, Sider D, et al. Coronary-artery calcification in young adults with end-stage renal disease who are undergoing dialysis. N Engl J Med. 2000;342:1478–83.CrossRefPubMed
64.
Bolland MJ, Barber PA, Doughty RN, Mason B, Horne A, Ames R, et al. Vascular events in healthy older women receiving calcium supplementation: randomised controlled trial. BMJ. 2008;336:262–6.CrossRefPubMedPubMedCentral
65.
Bolland MJ, Grey A, Avenell A, Gamble GD, Reid IR. Calcium supplements with or without vitamin D and risk of cardiovascular events: reanalysis of the Women’s Health Initiative limited access dataset and meta-analysis. Bmj. 2011;342:d2040.CrossRefPubMedPubMedCentral
66.
Bolland MJ, Avenell A, Baron JA, Grey A, MacLennan GS, Gamble GD, et al. Effect of calcium supplements on risk of myocardial infarction and cardiovascular events: meta-analysis. Bmj. 2010;341:c3691.CrossRefPubMedPubMedCentral
67.
Xiao Q, Murphy RA, Houston DK, et al. Dietary and supplemental calcium intake and cardiovascular disease mortality. The National Institute of Health-AARP Diet and Health Study. JAMA. 2013;173(8):639–46.
68.
69.
70.
71.
72.
73.
Alehagen U, Aaseth J, Alexander J, Johansson P. Still reduced cardiovascular mortality 12 years after supplementation with selenium and coenzyme Q10 for four years: a validation of previous 10-year follow-up results of a prospective randomized double-blind placebo-controlled trial in elderly. PLoS One. 2018;13(4):e0193120.CrossRefPubMedPubMedCentral
74.
75.
Von Haehling S, Jankowska EA, Van Veldhuisen DJ, Ponikowski P, Anker SD. Iron deficiency and cardiovascular disease. Nat Rev Cardiol. 2015;12(11):659.CrossRef
76.
Ponikowski P, Van Veldhuisen DJ, Comin-Colet J, Ertl G, Komajda M, Mareev V, et al. Beneficial effects of long-term intravenous iron therapy with ferric carboxymaltose in patients with symptomatic heart failure and iron deficiency. Eur Heart J. 2014;36(11):657–68.CrossRefPubMedPubMedCentral
77.
Danesh J, Appleby P. Coronary heart disease and iron status: meta-analyses of prospective studies. Circulation. 1999;99:852–4.CrossRefPubMed
78.
Lapice E, Masulli M, Vaccaro O. Iron deficiency and cardiovascular disease: an updated review of the evidence. Curr Atheroscler Rep. 2013;15(10):358.CrossRefPubMed
79.
Manson JE, Cook NR, Lee IM, Christen W, Bassuk SS, Mora S, et al. Marine n−3 fatty acids and prevention of cardiovascular disease and cancer. N Engl J Med. 2019;380(1):23–32.CrossRefPubMed
80.
Mozaffarian D, Rimm EB. Fish intake, contaminants, and human health: evaluating the risks and the benefits. JAMA. 2006;296:1885–99.CrossRefPubMed
81.
Mozaffarian D, Wu JH. Omega-3 fatty acids and cardiovascular disease: effects on risk factors, molecular pathways, and clinical events. J Am Coll Cardiol. 2011;58:2047–67.CrossRefPubMed
82.
Bowman L, Mafham M, Wallendszus K, et al. Effects of n−3 fatty acid supplements in diabetes mellitus. N Engl J Med. 2018;379:1540–50.CrossRefPubMed
83.
Rizos EC, Ntzani EE, Bika E, Kostapanos MS, Elisaf MS. Association between omega-3 fatty acid supplementation and risk of major cardiovascular disease events: a systematic review and meta-analysis. JAMA. 2012;308:1024–33.CrossRefPubMed
84.
Aung T, Halsey J, Kromhout D, Gerstein HC, Marchioli R, Tavazzi L, et al. Associations of omega-3 fatty acid supplement use with cardiovascular disease risks: meta-analysis of 10 trials involving 77 917 individuals. JAMA Cardiol. 2018;3:225–34.CrossRefPubMed
85.
Abdelhamid AS, Brown TJ, Brainard JS, et al. Omega-3 fatty acids for the primary and secondary prevention of cardiovascular disease. Cochrane Database Syst Rev. 2018;7:CD003177–7.
86.
Benstoem C, Goetzenich A, Kraemer S, Borosch S, Manzanares W, Hardy G, et al. Selenium and its supplementation in cardiovascular disease—what do we know? Nutrients. 2015;7(5):3094–118.CrossRefPubMedPubMedCentral
87.
Xu GL, Wang SC, Gu BQ, Yang YX, Song HB, Xue WL, et al. Further investigation on the role of selenium deficiency in the aetiology and pathogenesis of Keshan disease. Biomed Environ Sci. 1997;10:316–26.PubMed
88.
Flores-Mateo G, Navas-Acien A, Pastor-Barriuso R, Guallar E. Selenium and coronary heart disease: a meta-analysis. Am J Clin Nutr. 2006;84:762–73.CrossRefPubMed
89.
Loscalzo J. Keshan disease, selenium deficiency, and the selenoproteome. N Engl J Med. 2014;370(18):1756–60.CrossRefPubMed
90.
91.
Mattila C, Knekt P, Männistö S, Rissanen H, Laaksonen MA, Montonen J, et al. Serum 25-hydroxyvitamin D concentration and subsequent risk of type 2 diabetes. Diabetes Care. 2007;30:2569–70.CrossRefPubMed
92.
Bonithon-Kopp C, Kronborg O, Giacosa A, Räth U, Faivre J, European Cancer Prevention Organisation Study Group. Calcium and fibre supplementation in prevention of colorectal adenoma recurrence: a randomised intervention trial. Lancet. 2000;356:1300–6.CrossRefPubMed
Metadata
Title
Supplemental Vitamins and Minerals for Cardiovascular Disease Prevention and Treatment
Authors
David Perez Ingles
Jose B. Cruz Rodriguez
Hernando Garcia
Publication date
01-04-2020
Publisher
Springer US
Published in
Current Cardiology Reports / Issue 4/2020
Print ISSN: 1523-3782
Electronic ISSN: 1534-3170
DOI
https://doi.org/10.1007/s11886-020-1270-1

Other articles of this Issue 4/2020

Current Cardiology Reports 4/2020 Go to the issue

Regenerative Medicine (SM Wu, Section Editor)

Diversity of Organism-Wide and Organ-Specific Endothelial Cells

Ischemic Heart Disease (D Mukherjee, Section Editor)

Sex Differences in Coronary Artery Calcium and Long-term CV Mortality

Ischemic Heart Disease (D Mukherjee, Section Editor)

The Clinical Significance of Physiological Assessment of Residual Ischemia After Percutaneous Coronary Intervention

Congenital Heart Disease (RA Krasuski, Section Editor)

What Every Cardiologist Should Know About the 2018 Updated Adult Congenital Cardiology Guidelines

Ischemic Heart Disease (D Mukherjee, Section Editor)

Current Use and Trends in Unprotected Left Main Coronary Artery Percutaneous Intervention

Cardiac PET, CT, and MRI (P Schoenhagen and H Chen, Section Editors)

3D Printing Applications for Transcatheter Aortic Valve Replacement

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

Watch now

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits