The U.S. Preventive Services Task Force (USPSTF) recommends against the use of beta-carotene or vitamin E supplements for the prevention of cardiovascular disease or cancer, according to a recommendation statement published June 21 in the Journal of the American Medical Association (JAMA). Further, the USPSTF states that the current evidence is insufficient to make a recommendation about the use of multivitamin and single- or paired-nutrient supplements (other than beta-carotene and vitamin E) for the prevention of cardiovascular disease or cancer.

Elizabeth A. O'Connor, PhD, et al., updated the evidence report on the benefits and harms of vitamin and mineral supplementation in healthy adults for cardiovascular disease and cancer prevention to inform this recommendation. The researchers found vitamin and mineral supplementation was associated with little or no benefit in preventing cancer, cardiovascular disease, and death, except for a small benefit for cancer incidence with multivitamin use. Beta-carotene was associated with an increased risk of lung cancer and other harmful outcomes in persons at high risk of lung cancer.

According to National Health and Nutrition Examination Survey data, 52% of surveyed adults reported using at least one dietary supplement in the prior 30 days and 31% reported using a multivitamin-mineral supplement. Inflammation and oxidative stress have been shown to have a role in both cardiovascular disease and cancer, and dietary supplements may have anti-inflammatory and antioxidative effects. This has served as a rationale for proposing dietary supplements to prevent both cardiovascular disease and cancer.

The USPSTF recommendation replaces and is consistent with its 2014 statement.

In an accompanying editorial comment, Jenny Jia, MD, MSc, et al., draw attention to the concerning focus on dietary supplements in the consumer market, writing that these products are "relatively unregulated" by the U.S. Food and Drug Administration and "might be viewed as a potentially harmful distraction." Instead, they emphasize the need for greater focus on "lower-risk, higher-benefit activities" and efforts that would support people in accessing regular, evidence-based preventive services and care.

In another editorial comment, Peter A. Ubel, MD, asks this in light of the recommendation: "In the face of such underwhelming benefits, what explains the number of people who regularly consume these unnecessary supplements?" Ubel recommends addressing the psychological factors that feed the stark contrast between the popularity of vitamins and dietary supplements and their unproven benefits.

"More than half of adults in the U.S. take over-the-counter supplements and spend more than $500 billion a year on them despite a lack of scientific evidence," said Eugene Yang, MD, FACC, chair of ACC's Prevention of Cardiovascular Disease Section. The USPSTF released on June 21 updated guidelines for the use of vitamin and mineral supplements for primary prevention of cancer and cardiovascular disease. The update includes 52 new studies published since the 2014 guideline. Despite the addition of these trials, the recommendations remain the same. Beta-carotene and vitamin E supplementation are harmful and should be avoided. There is insufficient evidence to determine the balance of benefit vs. harm for multivitamins and other nutrient supplements. All clinicians should take a detailed history about over-the-counter supplement use. It is important to recognize that these recommendations from the USPSTF apply to persons who are not pregnant and exclude those with nutritional deficiencies."

A JAMA patient page is also available to further explain the recommendations about the use of vitamins, minerals, and multivitamins to prevent cardiovascular disease and cancer.

Clinical Topics: Cardio-Oncology, Prevention, Nonstatins, Diet, Stress

Keywords: beta Carotene, Vitamins, Dietary Supplements, Primary Prevention, Vitamin E, Minerals, Malnutrition, Anti-Inflammatory Agents, Oxidative Stress, Inflammation, Lung Neoplasms, Cardiotoxicity

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