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JOURNAL ARTICLE
RANDOMIZED CONTROLLED TRIAL

Multivitamins in the prevention of cardiovascular disease in men: the Physicians' Health Study II randomized controlled trial

Howard D Sesso, William G Christen, Vadim Bubes, Joanne P Smith, Jean MacFadyen, Miriam Schvartz, JoAnn E Manson, Robert J Glynn, Julie E Buring, J Michael Gaziano
JAMA: the Journal of the American Medical Association 2012 November 7, 308 (17): 1751-60
23117775

CONTEXT: Although multivitamins are used to prevent vitamin and mineral deficiency, there is a perception that multivitamins may prevent cardiovascular disease (CVD). Observational studies have shown inconsistent associations between regular multivitamin use and CVD, with no long-term clinical trials of multivitamin use.

OBJECTIVE: To determine whether long-term multivitamin supplementation decreases the risk of major cardiovascular events among men.

DESIGN, SETTING, AND PARTICIPANTS: The Physicians' Health Study II, a randomized, double-blind, placebo-controlled trial of a common daily multivitamin, began in 1997 with continued treatment and follow-up through June 1, 2011. A total of 14,641 male US physicians initially aged 50 years or older (mean, 64.3 [SD, 9.2] years), including 754 men with a history of CVD at randomization, were enrolled.

INTERVENTION: Daily multivitamin or placebo.

MAIN OUTCOME MEASURES: Composite end point of major cardiovascular events, including nonfatal myocardial infarction (MI), nonfatal stroke, and CVD mortality. Secondary outcomes included MI and stroke individually.

RESULTS: During a median follow-up of 11.2 (interquartile range, 10.7-13.3) years, there were 1732 confirmed major cardiovascular events. Compared with placebo, there was no significant effect of a daily multivitamin on major cardiovascular events (11.0 and 10.8 events per 1000 person-years for multivitamin vs placebo, respectively; hazard ratio [HR], 1.01; 95% CI, 0.91-1.10; P = .91). Further, a daily multivitamin had no effect on total MI (3.9 and 4.2 events per 1000 person-years; HR, 0.93; 95% CI, 0.80-1.09; P = .39), total stroke (4.1 and 3.9 events per 1000 person-years; HR, 1.06; 95% CI, 0.91-1.23; P = .48), or CVD mortality (5.0 and 5.1 events per 1000 person-years; HR, 0.95; 95% CI, 0.83-1.09; P = .47). A daily multivitamin was also not significantly associated with total mortality (HR, 0.94; 95% CI, 0.88-1.02; P = .13). The effect of a daily multivitamin on major cardiovascular events did not differ between men with or without a baseline history of CVD (P = .62 for interaction).

CONCLUSION: Among this population of US male physicians, taking a daily multivitamin did not reduce major cardiovascular events, MI, stroke, and CVD mortality after more than a decade of treatment and follow-up.

TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00270647.

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