Vitamin, Mineral, and Multivitamin Supplementation to Prevent Cardiovascular Disease and Cancer

Overview

This recommendation statement from the US Preventive Services Task Force (USPSTF), published in JAMA in 2022, updates its 2014 guidance on whether vitamin, mineral and multivitamin supplements help prevent cardiovascular disease and cancer. Dietary supplements are widely used, often to support general health or fill nutrient gaps, and inflammation and oxidative stress play a role in both conditions. The Task Force commissioned a systematic review of single nutrients, functionally related nutrient pairs and multivitamins, covering benefits and harms in community-dwelling, nonpregnant adults.

Recommendations

The USPSTF recommends against beta carotene or vitamin E supplements for the prevention of cardiovascular disease or cancer (grade D). It concludes that the evidence is insufficient to assess the balance of benefits and harms of multivitamins, or of single or paired nutrients other than beta carotene and vitamin E, for this purpose (I statements). These conclusions match those of 2014. The guidance does not apply to children, people who are or may become pregnant, people who are chronically ill or hospitalized, or those with a known nutritional deficiency. A separate USPSTF recommendation advises folic acid supplementation for anyone planning or capable of pregnancy.

Supporting evidence

Beta carotene provided no benefit and increased lung cancer risk in people who smoke or have occupational asbestos exposure; pooled trials also suggested higher cardiovascular mortality. Vitamin E showed no benefit on mortality, cardiovascular disease or cancer. Multivitamin trials found no clear effect on mortality and inconsistent results for cancer, and many were short or limited to specific groups. Vitamin D, with or without calcium, did not change mortality, cardiovascular events or cancer incidence, and evidence for calcium, folic acid, vitamin C, selenium and several B vitamins was limited or inconclusive.

Harms and practical considerations

For most supplements there was little evidence of serious harm, but excessive intake can cause problems, including effects of vitamin A on bone and liver and of high-dose vitamin D on calcium levels and kidney stones. Clinicians should use their judgement for individual patients. Other organizations advise meeting nutritional needs mainly through a varied, nutrient-dense diet. The Task Force calls for longer trials and for research on differences by baseline nutrient status, food insecurity and population group.