Kim Joonseok, Choi Jaehyoung, Kwon Soo Young, McEvoy John W, Blaha Michael J, Blumenthal Roger S, Guallar Eliseo, Zhao Di, Michos Erin D
Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham (J.K.).
Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University, Baltimore, MD (J.K., J.W.M., M.J.B., R.S.B., E.D.M.).
Circ Cardiovasc Qual Outcomes. 2018 Jul;11(7):e004224. doi: 10.1161/CIRCOUTCOMES.117.004224.
Multiple studies have attempted to identify the association between multivitamin/mineral (MVM) supplementation and cardiovascular disease (CVD) outcomes, but the benefits remain controversial. We performed a systematic review and meta-analysis of the associations between MVM supplementation and various CVD outcomes, including coronary heart disease (CHD) and stroke.
We conducted a comprehensive search of Medline, Embase, and the Cochrane Library for studies published between January 1970 and August 2016. We included clinical trials and prospective cohort studies in the general population evaluating associations between MVM supplementation and CVD outcomes. Data extraction and quality assessment were independently conducted by 2 authors, and a third author resolved discrepancies. Eighteen studies with 2 019 862 participants and 18 363 326 person-years of follow-up were included in the analysis. Five studies specified the dose/type of MVM supplement and the rest did not. Overall, there was no association between MVM supplementation and CVD mortality (relative risk [RR], 1.00; 95% confidence interval [CI], 0.97-1.04), CHD mortality (RR, 1.02; 95% CI, 0.92-1.13), stroke mortality (RR, 0.95; 95% CI, 0.82-1.09), or stroke incidence (RR, 0.98; 95% CI, 0.91-1.05). There was no association between MVM supplements and CVD or CHD mortality in prespecified subgroups categorized by mean follow-up period, mean age, period of MVM use, sex, type of population, exclusion of patients with history of CHD, and adjustment for diet, adjustment for smoking, adjustment for physical activity, and study site. In contrast, MVM use did seem to be associated with a lower risk of CHD incidence (RR, 0.88; 95% CI, 0.79-0.97). However, this association did not remain significant in the pooled subgroup analysis of randomized controlled trials (RR, 0.97; 95% CI, 0.80-1.19).
Our meta-analysis of clinical trials and prospective cohort studies demonstrates that MVM supplementation does not improve cardiovascular outcomes in the general population.
多项研究试图确定补充多种维生素/矿物质（MVM）与心血管疾病（CVD）结局之间的关联，但益处仍存在争议。我们对补充MVM与包括冠心病（CHD）和中风在内的各种CVD结局之间的关联进行了系统评价和荟萃分析。
我们全面检索了1970年1月至2016年8月期间发表在Medline、Embase和Cochrane图书馆的研究。我们纳入了评估补充MVM与CVD结局之间关联的普通人群中的临床试验和前瞻性队列研究。数据提取和质量评估由两名作者独立进行，第三名作者解决分歧。分析纳入了18项研究，共2019862名参与者，随访时间总计18363326人年。五项研究明确了MVM补充剂的剂量/类型，其余研究未明确。总体而言，补充MVM与CVD死亡率（相对风险[RR]，1.00；95%置信区间[CI]，0.97 - 1.04）、CHD死亡率（RR，1.02；95% CI，0.92 - 1.13）、中风死亡率（RR，0.95；95% CI，0.82 - 1.09）或中风发病率（RR，0.98；95% CI，0.91 - 1.05）之间无关联。在按平均随访期、平均年龄、MVM使用期、性别、人群类型、排除CHD病史患者以及饮食调整、吸烟调整、体力活动调整和研究地点分类的预先指定亚组中，MVM补充剂与CVD或CHD死亡率之间无关联。相比之下，使用MVM似乎与较低的CHD发病率风险相关（RR，0.88；95% CI，0.79 - 0.97）。然而，在随机对照试验的汇总亚组分析中，这种关联并不显著（RR，0.97；95% CI，0.80 - 1.19）。
我们对临床试验和前瞻性队列研究的荟萃分析表明，补充MVM并不能改善普通人群的心血管结局。
