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Multivitamin/mineral supplementation and the risk of cardiovascular disease: a large prospective study using UK Biobank data

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Abstract

Purpose

Despite the widespread use of multivitamin/mineral supplements, the effects of multivitamin/mineral on cardiovascular disease (CVD) remain inconclusive. We aimed to prospectively investigate how multivitamin/mineral use is associated with CVD.

Methods

This population-based cohort study included 465,278 men and women who participated in the UK Biobank and were free from CVD at baseline. Participants were enrolled between 2006 and 2010 and followed-up until the end of 2018. Data on supplement use including multivitamin/mineral were collected using self-reported questionnaires. Cox proportional hazards models were used to estimate the hazard ratios of CVD events in relation to multivitamin/mineral use.

Results

During the follow-up, we identified 25,772 cases of CVD events, 4754 cases of CVD mortality, 18,728 cases of coronary heart disease, 6726 cases of myocardial infarction, and 4561 cases of stroke. The multivariable-adjusted hazard ratios associated with multivitamin/mineral use were 0.96 (95% CI: 0.93, 0.99) for CVD events, 0.92 (0.86, 1.00) for CVD mortality, 0.96 (0.93, 0.99) for coronary heart disease, and 0.92 (0.86, 0.97) for myocardial infarction. Subgroup analysis suggested that multivitamin/mineral use was associated with a significantly lower risk of CVD events in participants aged < 60 years and in former and current smokers (P for interaction ≤ 0.01). Sensitivity analyses showed no substantial change in the results when we excluded participants who developed CVD events during the first 2 years of follow-up.

Conclusion

Multivitamin/mineral supplementation was associated with very modest reductions in CVD events. Age and smoking might modify these associations.

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References

  1. Neuhouser ML (2003) Dietary supplement use by American women: challenges in assessing patterns of use, motives and costs. J Nutr 133(6):1992s–1996s. https://doi.org/10.1093/jn/133.6.1992S

    Article  PubMed  Google Scholar 

  2. Kim J, Choi J, Kwon SY, McEvoy JW, Blaha MJ, Blumenthal RS, Guallar E, Zhao D, Michos ED (2018) Association of multivitamin and mineral supplementation and risk of cardiovascular disease: a systematic review and meta-analysis. Circ Cardiovasc Qual Outcomes 11(7):e004224. https://doi.org/10.1161/circoutcomes.117.004224

    Article  PubMed  Google Scholar 

  3. Sesso HD, Christen WG, Bubes V, Smith JP, MacFadyen J, Schvartz M, Manson JE, Glynn RJ, Buring JE, Gaziano JM (2012) Multivitamins in the prevention of cardiovascular disease in men: the Physicians’ Health Study II randomized controlled trial. JAMA 308(17):1751–1760. https://doi.org/10.1001/jama.2012.14805

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Hercberg S, Galan P, Preziosi P, Bertrais S, Mennen L, Malvy D, Roussel AM, Favier A, Briançon S (2004) The SUVIMAX Study: a randomized, placebo-controlled trial of the health effects of antioxidant vitamins and minerals. Arch Intern Med 164(21):2335–2342. https://doi.org/10.1001/archinte.164.21.2335

    Article  CAS  PubMed  Google Scholar 

  5. Sherman RE, Anderson SA, Dal Pan GJ, Gray GW, Gross T, Hunter NL, LaVange L, Marinac-Dabic D, Marks PW, Robb MA, Shuren J, Temple R, Woodcock J, Yue LQ, Califf RM (2016) Real-world evidence—what is it and what can it tell us? N Engl J Med 375(23):2293–2297. https://doi.org/10.1056/NEJMsb1609216

    Article  PubMed  Google Scholar 

  6. Rautiainen S, Akesson A, Levitan EB, Morgenstern R, Mittleman MA, Wolk A (2010) Multivitamin use and the risk of myocardial infarction: a population-based cohort of Swedish women. Am J Clin Nutr 92(5):1251–1256. https://doi.org/10.3945/ajcn.2010.29371

    Article  CAS  PubMed  Google Scholar 

  7. Dong JY, Iso H, Kitamura A, Tamakoshi A (2015) Multivitamin use and risk of stroke mortality: the Japan collaborative cohort study. Stroke 46(5):1167–1172. https://doi.org/10.1161/strokeaha.114.008270

    Article  PubMed  Google Scholar 

  8. Adebamowo SN, Feskanich D, Stampfer M, Rexrode K, Willett WC (2017) Multivitamin use and risk of stroke incidence and mortality amongst women. Eur J Neurol 24(10):1266–1273. https://doi.org/10.1111/ene.13358

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Rautiainen S, Lee IM, Rist PM, Gaziano JM, Manson JE, Buring JE, Sesso HD (2015) Multivitamin use and cardiovascular disease in a prospective study of women. Am J Clin Nutr 101(1):144–152. https://doi.org/10.3945/ajcn.114.088310

    Article  CAS  PubMed  Google Scholar 

  10. Messerer M, Håkansson N, Wolk A, Akesson A (2008) Dietary supplement use and mortality in a cohort of Swedish men. Br J Nutr 99(3):626–631. https://doi.org/10.1017/s0007114507812049

    Article  CAS  PubMed  Google Scholar 

  11. Rautiainen S, Rist PM, Glynn RJ, Buring JE, Gaziano JM, Sesso HD (2016) Multivitamin use and the risk of cardiovascular disease in men. J Nutr 146(6):1235–1240. https://doi.org/10.3945/jn.115.227884

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Li K, Kaaks R, Linseisen J, Rohrmann S (2012) Vitamin/mineral supplementation and cancer, cardiovascular, and all-cause mortality in a German prospective cohort (EPIC-Heidelberg). Eur J Nutr 51(4):407–413. https://doi.org/10.1007/s00394-011-0224-1

    Article  CAS  PubMed  Google Scholar 

  13. Sudlow C, Gallacher J, Allen N, Beral V, Burton P, Danesh J, Downey P, Elliott P, Green J, Landray M, Liu B, Matthews P, Ong G, Pell J, Silman A, Young A, Sprosen T, Peakman T, Collins R (2015) UK biobank: an open access resource for identifying the causes of a wide range of complex diseases of middle and old age. PLoS Med 12(3):e1001779. https://doi.org/10.1371/journal.pmed.1001779

    Article  PubMed  PubMed Central  Google Scholar 

  14. Ma H, Li X, Sun D, Zhou T, Ley SH, Gustat J, Heianza Y, Qi L (2019) Association of habitual glucosamine use with risk of cardiovascular disease: prospective study in UK Biobank. BMJ (Clin Res ed) 365:l1628. https://doi.org/10.1136/bmj.l1628

    Article  Google Scholar 

  15. Tyrrell J, Jones SE, Beaumont R, Astley CM, Lovell R, Yaghootkar H, Tuke M, Ruth KS, Freathy RM, Hirschhorn JN, Wood AR, Murray A, Weedon MN, Frayling TM (2016) Height, body mass index, and socioeconomic status: mendelian randomisation study in UK Biobank. BMJ (Clin Res ed) 352:i582. https://doi.org/10.1136/bmj.i582

    Article  Google Scholar 

  16. Li ZH, Zhong WF, Liu S, Kraus VB, Zhang YJ, Gao X, Lv YB, Shen D, Zhang XR, Zhang PD, Huang QM, Chen Q, Wu XB, Shi XM, Wang D, Mao C (2020) Associations of habitual fish oil supplementation with cardiovascular outcomes and all cause mortality: evidence from a large population based cohort study. BMJ (Clin Res ed) 368:m456. https://doi.org/10.1136/bmj.m456

    Article  Google Scholar 

  17. Bull FC, Al-Ansari SS, Biddle S, Borodulin K, Buman MP, Cardon G, Carty C, Chaput JP, Chastin S, Chou R, Dempsey PC, DiPietro L, Ekelund U, Firth J, Friedenreich CM, Garcia L, Gichu M, Jago R, Katzmarzyk PT, Lambert E, Leitzmann M, Milton K, Ortega FB, Ranasinghe C, Stamatakis E, Tiedemann A, Troiano RP, van der Ploeg HP, Wari V, Willumsen JF (2020) World Health Organization 2020 guidelines on physical activity and sedentary behaviour. Br J Sports Med 54(24):1451–1462. https://doi.org/10.1136/bjsports-2020-102955

    Article  PubMed  Google Scholar 

  18. Holmquist C, Larsson S, Wolk A, de Faire U (2003) Multivitamin supplements are inversely associated with risk of myocardial infarction in men and women–Stockholm Heart Epidemiology Program (SHEEP). J Nutr 133(8):2650–2654. https://doi.org/10.1093/jn/133.8.2650

    Article  CAS  PubMed  Google Scholar 

  19. Bailey RL, Fakhouri TH, Park Y, Dwyer JT, Thomas PR, Gahche JJ, Miller PE, Dodd KW, Sempos CT, Murray DM (2015) Multivitamin-mineral use is associated with reduced risk of cardiovascular disease mortality among women in the United States. J Nutr 145(3):572–578. https://doi.org/10.3945/jn.114.204743

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Watkins ML, Erickson JD, Thun MJ, Mulinare J, Heath CW Jr (2000) Multivitamin use and mortality in a large prospective study. Am J Epidemiol 152(2):149–162. https://doi.org/10.1093/aje/152.2.149

    Article  CAS  PubMed  Google Scholar 

  21. Jenkins DJA, Spence JD, Giovannucci EL, Kim YI, Josse RG, Vieth R, Sahye-Pudaruth S, Paquette M, Patel D, Blanco Mejia S, Viguiliouk E, Nishi SK, Kavanagh M, Tsirakis T, Kendall CWC, Pichika SC, Sievenpiper JL (2021) Supplemental vitamins and minerals for cardiovascular disease prevention and treatment: JACC focus seminar. J Am Coll Cardiol 77(4):423–436. https://doi.org/10.1016/j.jacc.2020.09.619

    Article  CAS  PubMed  Google Scholar 

  22. Salonen RM, Nyyssönen K, Kaikkonen J, Porkkala-Sarataho E, Voutilainen S, Rissanen TH, Tuomainen TP, Valkonen VP, Ristonmaa U, Lakka HM, Vanharanta M, Salonen JT, Poulsen HE (2003) Six-year effect of combined vitamin C and E supplementation on atherosclerotic progression: the Antioxidant Supplementation in Atherosclerosis Prevention (ASAP) Study. Circulation 107(7):947–953. https://doi.org/10.1161/01.cir.0000050626.25057.51

    Article  CAS  PubMed  Google Scholar 

  23. Messner B, Bernhard D (2014) Smoking and cardiovascular disease: mechanisms of endothelial dysfunction and early atherogenesis. Arterioscler Thromb Vasc Biol 34(3):509–515. https://doi.org/10.1161/atvbaha.113.300156

    Article  CAS  PubMed  Google Scholar 

  24. Rautiainen S, Wang L, Lee IM, Manson JE, Gaziano JM, Buring JE, Sesso HD (2016) Multivitamin use and the risk of hypertension in a prospective cohort study of women. J Hypertens 34(8):1513–1519. https://doi.org/10.1097/hjh.0000000000000973

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Steinberg D, Witztum JL (2002) Is the oxidative modification hypothesis relevant to human atherosclerosis? Do the antioxidant trials conducted to date refute the hypothesis? Circulation 105(17):2107–2111. https://doi.org/10.1161/01.cir.0000014762.06201.06

    Article  PubMed  Google Scholar 

  26. Hansson GK (2005) Inflammation, atherosclerosis, and coronary artery disease. N Engl J Med 352(16):1685–1695. https://doi.org/10.1056/NEJMra043430

    Article  CAS  PubMed  Google Scholar 

  27. Homocysteine and risk of ischemic heart disease and stroke: a meta-analysis (2002). JAMA 288(16):2015–2022. doi:https://doi.org/10.1001/jama.288.16.2015

  28. McNulty H, Pentieva K, Hoey L, Ward M (2008) Homocysteine, B-vitamins and CVD. Proc Nutr Soc 67(2):232–237. https://doi.org/10.1017/s0029665108007076

    Article  CAS  PubMed  Google Scholar 

  29. McGreevy C, Williams D (2011) New insights about vitamin D and cardiovascular disease: a narrative review. Ann Intern Med 155(12):820–826. https://doi.org/10.7326/0003-4819-155-12-201112200-00004

    Article  PubMed  Google Scholar 

  30. Rose AH, Hoffmann PR (2015) Selenoproteins and cardiovascular stress. Thromb Haemost 113(3):494–504. https://doi.org/10.1160/th14-07-0603

    Article  PubMed  Google Scholar 

  31. Muñoz-Castañeda JR, Pendón-Ruiz de Mier MV, Rodríguez M, Rodríguez-Ortiz ME (2018) Magnesium replacement to protect cardiovascular and kidney damage? Lack of prospective clinical trials. Int J Mol Sci. https://doi.org/10.3390/ijms19030664

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

We thank UK Biobank participants. This research has been conducted using the UK Biobank Resource (application No 52632).

Funding

This study is supported by the National Natural Science Foundation of China (82173648), Innovative Talent Support Plan of the Medical and Health Technology Project in Zhejiang Province (2021422878), Internal Fund of Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences (2020YJY0212), Ningbo Clinical Research Center for Digestive System Tumors (2019A21003), and Sanming Project of Medicine in Shenzhen (SZSM201803080).

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Authors and Affiliations

  1. Department of Global Health, Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, 159 Beijiao Road, Jiangbei District, Ningbo, 153000, Zhejiang Province, People’s Republic of China

    Ruijie Zhang, Meng Wang & Liyuan Han

  2. Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, 199 Renai Road, Industrial Park District, Suzhou, 215123, Jiangsu Province, People’s Republic of China

    Bizhong Che, Chongke Zhong & Yonghong Zhang

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  1. Bizhong Che
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  2. Chongke Zhong
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  4. Meng Wang
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  5. Yonghong Zhang
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  6. Liyuan Han
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Contributions

LH and YZ: conceptualized the manuscript; BC, CZ, and LH: contributed to the literature search and interpretation, the statistical analysis, the writing of the paper, and refining of figures and tables; RZ and MW: conducted the data collection; LH and YZ had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis; and all authors: reviewed and revised the manuscript, read and approved the final manuscript.

Corresponding authors

Correspondence to Yonghong Zhang or Liyuan Han.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standards

This study was performed under generic ethical approval obtained by UK Biobank investigators from the National Health Service National Research Ethics Service (Ref: 11/NW/0.0382) and all participants provided written informed consent. The current analyses were carried out under application number 52632.

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Cite this article

Che, B., Zhong, C., Zhang, R. et al. Multivitamin/mineral supplementation and the risk of cardiovascular disease: a large prospective study using UK Biobank data. Eur J Nutr 61, 2909–2917 (2022). https://doi.org/10.1007/s00394-022-02865-4

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  • DOI: https://doi.org/10.1007/s00394-022-02865-4

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