US Preventive Services Task Force - vitamin, mineral, and multivitamin supplementation to prevent cardiovascular disease and cancer - summary

Last edited 06/2022 and last reviewed 04/2023

US Preventive Services Task Force - Vitamin, Mineral, and Multivitamin Supplementation to Prevent Cardiovascular Disease and Cancer

Recommendations apply to community-dwelling, nonpregnant adults

• does not apply to children, persons who are pregnant or may become pregnant, or persons who are chronically ill, are hospitalized, or have a known nutritional deficiency

Summary points:

• the US Preventive Services Task Force (USPSTF) concludes with moderate certainty that the harms of beta carotene supplementation outweigh the benefits for the prevention of cardiovascular disease or cancer. The USPSTF also concludes with moderate certainty that there is no net benefit of supplementation with vitamin E for the prevention of cardiovascular disease or cancer
  
  
• the USPSTF concludes that the evidence is insufficient to determine the balance of benefits and harms of supplementation with multivitamins for the prevention of cardiovascular disease or cancer. Evidence is lacking and the balance of benefits and harms cannot be determined
  
  
• the USPSTF concludes that the evidence is insufficient to determine the balance of benefits and harms of supplementation with single or paired nutrients (other than beta carotene and vitamin E) for the prevention of cardiovascular disease or cancer. Evidence is lacking and the balance of benefits and harms cannot be determined

Potential Harms

• for many of the vitamins and nutrients reviewed, there was little evidence of serious harms. However, an important harm of increased lung cancer incidence was reported with the use of beta carotene by persons who smoke tobacco or have occupational exposure to asbestos
  • study showed that supplementation with beta-carotene increased the risk of lung cancer in smokers regardless of the tar or nicotine content of cigarettes smoked (2)
• excessive doses of vitamin supplements can cause several known adverse effects; for example, moderate doses of vitamin A supplements may reduce bone mineral density, and high doses may be hepatotoxic or teratogenic. Vitamin D has potential harms, such as a risk of hypercalcemia and kidney stones, when given at high doses. The potential for harm from other supplements at high doses should be carefully considered

"..Based on current evidence, the USPSTF concludes with moderate certainty that the harms of beta carotene supplementation for the prevention of cardiovascular disease or cancer outweigh the benefits. The USPSTF concludes with moderate certainty that there is no net benefit of supplementation with vitamin E for the prevention of cardiovascular disease or cancer. For other single or paired nutrients as well as multivitamins, the evidence is insufficient to determine the balance of benefits and harms of supplementation for the prevention of cardiovascular disease or cancer..." (3)

Reference:

• US Preventive Services Task Force. Vitamin, Mineral, and Multivitamin Supplementation to Prevent Cardiovascular Disease and Cancer: US Preventive Services Task Force Recommendation Statement. JAMA. 2022;327(23):2326–2333. doi:10.1001/jama.2022.8970
• Middha P et al. Beta-Carotene Supplementation and Lung Cancer Incidence in the Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study: The Role of Tar and Nicotine. Nicotine Tob Res. 2019;21(8):1045-1050. doi:10.1093/ntr/nty115
• Jin J. Vitamins and Minerals to Prevent Cardiovascular Disease and Cancer. JAMA. 2022;327(23):2364. doi:10.1001/jama.2022.10009.