Adebamowo S N, Feskanich D, Stampfer M, Rexrode K, Willett W C
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA.
Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
Eur J Neurol. 2017 Oct;24(10):1266-1273. doi: 10.1111/ene.13358. Epub 2017 Jul 30.
Few studies have examined the association between multivitamin use and the risk of stroke incidence and mortality, and the results remain inconclusive as to whether multivitamins are beneficial.
The associations between multivitamin use and the risk of incident stroke and stroke mortality were prospectively examined in 86 142 women in the Nurses' Health Study, aged 34-59 years and free of diagnosed cardiovascular disease at baseline. Multivitamin use and covariates were updated every 2 years and strokes were documented by review of medical records. Hazard ratios of total, ischaemic and hemorrhagic strokes were calculated across categories of multivitamin use (non-user, past, current user) and duration (years), using Cox proportional hazards models.
During 32 years of follow-up from 1980 to 2012, 3615 incident strokes were documented, including 758 deaths from stroke. In multivariate analyses, women who were current multivitamin users did not have a lower risk of incident total stroke compared to non-users [relative risk (RR) 1.02, 95% confidence interval (CI) 0.93-1.11], even those with longer durations of 15 or more years of use (RR 1.08, 95% CI 0.97-1.20) or those with a lower quality diet (RR 0.96, 95% CI 0.80-1.15). There was also no indication of benefit from multivitamin use for incident ischaemic or hemorrhagic strokes or for total stroke mortality.
Long-term multivitamin use was not associated with reduced risk of stroke incidence or mortality amongst women in the study population, even amongst those with a lower diet quality. An effect in a less well-nourished population cannot be ruled out.
很少有研究探讨多种维生素的使用与中风发病率及死亡率之间的关联,关于多种维生素是否有益的结果仍无定论。
在护士健康研究中,对86142名年龄在34至59岁之间、基线时无确诊心血管疾病的女性进行前瞻性研究,以探讨多种维生素的使用与中风发病风险及中风死亡率之间的关联。每2年更新一次多种维生素的使用情况及协变量,并通过查阅医疗记录记录中风情况。使用Cox比例风险模型计算不同多种维生素使用类别(非使用者、过去使用者、当前使用者)和使用时长(年)的总中风、缺血性中风和出血性中风的风险比。
在1980年至2012年的32年随访期间,记录了3615例中风事件,其中758例死于中风。在多变量分析中,与非使用者相比,当前使用多种维生素的女性发生总中风的风险并未降低[相对风险(RR)为1.02,95%置信区间(CI)为0.93 - 1.11],即使是使用时长为15年或更长时间的女性(RR为1.08,95%CI为0.97 - 1.20)或饮食质量较低的女性(RR为0.96,95%CI为0.80 - 1.15)。也没有迹象表明使用多种维生素对缺血性或出血性中风的发生或总中风死亡率有益。
在研究人群中的女性中,长期使用多种维生素与中风发病率或死亡率的降低无关,即使在饮食质量较低的女性中也是如此。不能排除在营养状况较差的人群中存在某种影响。