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Introduction

We conducted this systematic review to help the Agency for Healthcare Research and Quality (AHRQ) update its recommendation on the use of multivitamins for the prevention of cardiovascular disease (CVD) and cancer in the general population. The U.S. Preventive Services Task Force (USPSTF) will use this review to update its 2003 recommendations on routine vitamin supplementation to prevent chronic diseases. This review addresses the benefits and harms of single, paired, and multiple vitamins and/or minerals as primary prevention for CVD and cancer in the general population without nutritional deficiencies or existing chronic diseases.

Methods

AHRQ commissioned this evidence review on the use of multivitamins for the primary prevention of cancer and CVD in the general population to assist the USPSTF in updating its 2003 recommendation on routine vitamin supplementation. Our review is similar in scope to the three 2003 evidence reviews- the USPSTF used to develop its previous recommendation statement. These reviews, however, included a limited number of individual and combination vitamins and minerals (vitamins A, E, and C, “antioxidant combinations,” and “multivitamin preparations”) compared with our review, which includes additional supplements (e.g., calcium, vitamin D, folic acid). In addition, the previous reviews included any primary or secondary prevention study of vitamins or minerals that reported on the incidence or mortality of cancer or CVD, whereas our review focused on primary prevention.

Discussion

We conducted this systematic review to assist the USPSTF in updating its 2003 recommendation on using vitamin supplements to prevent CVD and cancer. Our review included 26 studies (24 RCTs and two cohort studies) examining the benefits and harms of vitamins and minerals as primary prevention of CVD, cancer, and all-cause mortality (Table 44). For most of the supplements analyzed in this report, we found no evidence of an effect for nutritional doses on CVD, cancer, or all-cause mortality in healthy individuals with a presumed generally adequate diet based on study inclusion criteria and baseline serum levels. Other systematic reviews generally support this perspective.- For most supplements, however, there were a limited number of studies on which to base this conclusion, with the exception of vitamin E, which included six fair- to good-quality trials that all produced clearly null effects on these endpoints, consistent with the conclusions of other systematic reviews and meta-analyses.-

Results

Our literature search yielded 12,766 unique citations. From these, we provisionally accepted 277 articles for review based on titles and abstracts (Appendix B Figure 1). After screening the full-text articles, we judged 26 studies (103 articles) to have met the inclusion criteria. We excluded the remaining 174 full-text articles (Appendix D).

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