Findings from The Physicians’ Health Study II (PHS II) suggest that baseline nutritional status does not impact the effect of long-term multivitamin use on preventing major cardiovascular disease (CVD) events.

In PHS II, long-term use of multivitamins had no impact on CVD risk, but it was unclear whether baseline nutritional status could explain the lack of effect. To investigate this, Susanne Rautiainen, PhD, from Brigham and Women’s Hospital, Boston, MA and her colleagues aimed to discover whether multivitamins may help prevent CVD events among those in the PHS II with less nutritious diets. 

PHS II was a randomized, double-blind, placebo-controlled trial that evaluated Centrum Silver vs. placebo daily among U.S. male physicians (n=14,641) aged ≥50 years. Of the total physicians, 91% completed a 116-item semiquantitative food frequency questionnaire and were included in the analyses. This study further looked at effect modification based on baseline intake of key foods, individual nutrients, dietary patterns, and dietary supplement use.  

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The study’s major outcomes included major cardiovascular events, including nonfatal myocardial infarction (MI), nonfatal stroke, and CVD mortality. 

The data revealed “no consistent evidence of effect modification by various foods, nutrients, dietary patterns, or baseline supplement use” with multivitamin use on CVD outcomes. The authors noted statistically significant associations between multivitamin use and vitamin B6 intake on MI as well as multivitamin use and vitamin D intake on CVD mortality. In addition, the interaction effects between multivitamin use and vitamin B12 intake on CVD mortality and total mortality were deemed statistically significant. 

“However, there were inconsistent patterns in hazard ratios across tertiles of each dietary factor that are likely explained by multiple testing,” noted Dr. Rautiainen. In general, baseline nutritional status did not impact the effect of long-term multivitamin use on major CVD events. More research is needed to evaluate the role of baseline nutritional biomarkers and multivitamin use on other clinical outcomes.

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