Watkins M L, Erickson J D, Thun M J, Mulinare J, Heath C W
Centers for Disease Control and Prevention, National Center for Environmental Health, Division of Birth Defects, Child Development, Disability and Health, Birth Defects and Pediatric Genetics Branch, Atlanta, GA 30341-3717, USA.
Am J Epidemiol. 2000 Jul 15;152(2):149-62. doi: 10.1093/aje/152.2.149.
To determine the relation between multivitamin use and death from heart disease, cerebrovascular disease, and cancer, the authors examined a prospective cohort of 1,063,023 adult Americans in 1982-1989 and compared the mortality of users of multivitamins alone; vitamin A, C, or E alone; and multivitamin and vitamin A, C, or E in combination with that of vitamin nonusers by using multivariate Cox proportional hazard models. Multivitamin users had heart disease and cerebrovascular disease mortality risks similar to those of nonusers, whereas combination users had mortality risks that were 15% lower than those of nonusers. Multivitamin and combination use had minimal effect on cancer mortality overall, although mortality from all cancers combined was increased among male current smokers who used multivitamins alone (relative risk (RR) = 1.13, 95% confidence interval (CI): 1.05, 1.23) or in combination with vitamin A, C, or E (RR = 1.16, 95% CI: 1.06, 1.26), but decreased in male combination users who had never (RR = 0.86, 95% CI: 0.74, 0.99) or had formerly (RR = 0.90, 95% CI: 0.82, 0.98) smoked. No such associations were seen in women. These observational data provide limited support for the hypothesis that multivitamin use in combination with vitamin A, C, or E may reduce heart disease and cardiovascular disease mortality, but add to concerns raised by randomized studies that some vitamin supplements may adversely affect male smokers.
为了确定多种维生素的使用与心脏病、脑血管疾病和癌症死亡之间的关系，作者在1982年至1989年期间对1,063,023名美国成年人群体进行了前瞻性队列研究，并使用多变量Cox比例风险模型比较了单独使用多种维生素者、单独使用维生素A、C或E者，以及同时使用多种维生素和维生素A、C或E者与不使用维生素者的死亡率。单独使用多种维生素者的心脏病和脑血管疾病死亡风险与不使用者相似，而同时使用多种维生素和维生素A、C或E者的死亡风险比不使用者低15%。多种维生素单独使用和联合使用对总体癌症死亡率的影响最小，不过在单独使用多种维生素（相对风险（RR）=1.13，95%置信区间（CI）：1.05，1.23）或同时使用多种维生素和维生素A、C或E（RR = 1.16，95% CI：1.06，1.26）的男性当前吸烟者中，所有癌症合并死亡率有所增加，但在从未（RR = 0.86，95% CI：0.74，0.99）或曾经（RR = 0.90，95% CI：0.82，0.98）吸烟的男性联合使用者中则有所降低。在女性中未观察到此类关联。这些观察性数据为多种维生素与维生素A、C或E联合使用可能降低心脏病和心血管疾病死亡率这一假设提供了有限的支持，但也增加了随机研究提出的一些担忧，即某些维生素补充剂可能对男性吸烟者产生不利影响。
