Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, St. Michael's Hospital, Toronto, Ontario, Canada; Clinical Nutrition Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada; Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto, Ontario, Canada.
Stroke Prevention & Atherosclerosis Research Centre, Robarts Research Institute, Western University, London, Ontario, Canada.
J Am Coll Cardiol. 2018 Jun 5;71(22):2570-2584. doi: 10.1016/j.jacc.2018.04.020.
The authors identified individual randomized controlled trials from previous meta-analyses and additional searches, and then performed meta-analyses on cardiovascular disease outcomes and all-cause mortality. The authors assessed publications from 2012, both before and including the U.S. Preventive Service Task Force review. Their systematic reviews and meta-analyses showed generally moderate- or low-quality evidence for preventive benefits (folic acid for total cardiovascular disease, folic acid and B-vitamins for stroke), no effect (multivitamins, vitamins C, D, β-carotene, calcium, and selenium), or increased risk (antioxidant mixtures and niacin [with a statin] for all-cause mortality). Conclusive evidence for the benefit of any supplement across all dietary backgrounds (including deficiency and sufficiency) was not demonstrated; therefore, any benefits seen must be balanced against possible risks.
作者从之前的荟萃分析和额外的搜索中确定了个体随机对照试验,然后对心血管疾病结局和全因死亡率进行了荟萃分析。作者评估了 2012 年的出版物,包括美国预防服务工作组审查之前和之后的出版物。他们的系统评价和荟萃分析显示,预防益处的证据总体上为中等到低质量(叶酸对全因心血管疾病、叶酸和 B 族维生素对中风),没有效果(多种维生素、维生素 C、D、β-胡萝卜素、钙和硒),或者风险增加(抗氧化混合物和烟酸[与他汀类药物]对全因死亡率)。没有证据表明任何补充剂在所有饮食背景下(包括缺乏和充足)都有获益;因此,任何益处都必须与可能的风险相平衡。