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You Are Here: AHRQ Home > Clinical Information > U.S. Preventive Services Task Force (USPSTF) > Guide to Clinical Preventive Services, 2001-2004 > Counseling: Vitamin Supplementation to Prevent Cancer & Cardiovascular Disease > Summary of Evidence

Table 1. Cohort Studies of the Association Between Vitamin Supplement Use and Cardiovascular Disease Risk

Study, Publication, Year
(Quality Score)		 Description Outcomes, Comparison Factors Adjusted for in Analysis Vitamin A Vitamin C Vitamin E Anti-Oxidant Combinations Multivitamin Preparations
Nurses' Health Study
Stampfer, 199318
(Good)		 87,245 female US nurses, age 34-59, with no history of cancer, angina, myocardial infarction, stroke, or other cardiovascular disease; 552 cases of major coronary disease; 97.1% follow-up at 8 years. Major coronary disease (nonfatal myocardial infarction or death due to coronary disease), in users vs. non-users. Age, time period, quetelet index*, smoking, alcohol intake, menopausal status, postmenopausal hormone use, exercise, regular use of aspirin, hypertension, high cholesterol, diabetes, total energy intake, use of vitamin E supplements, use of multivitamin supplements.     0.63
(0.45-0.88)		   0.87
(0.70-1.07)
Nurses' Health Study
Rimm, 199819
(Good)		 80,082 female US nurses, Same as above plus no hypercholesterolemia or diabetes; 658 cases if nonfatal myocardial infarction and 281 fatal coronary deaths; 98% follow-up for mortality at 14 years. Incident nonfatal myocardial infarction and coronary death, in users (4-7 pills/week) vs. non-users. Age, time period, body mass index, smoking, menopausal status, hormone replacement therapy use, aspirin, vitamin E supplements, physical activity, hypertension, parental history of myocardial infarction < age 65, alcohol, and quintiles of fiber, alcohol, and saturated, polyunsaturated, and trans fat.         0.76
(0.65-0.90)
Health Professionals' Study
Rimm, 199320
(Good)		 39,910 male US health professionals age 40-75; 667 incident cases of coronary disease; 96% follow-up at 4 years. Incident coronary disease (fatal coronary disease, nonfatal myocardial infarction, CABG, angioplasty). Comparing users vs. non-users. Age, smoking, body-mass index, total calories, dietary fiber, alcohol consumption, hypertension, regular aspirin use, physical activity, parental history of myocardial infarction < age 60, profession.     0.75
(0.61-0.93)		    
Iowa Women's Health Study
Kushi, 199621
(Good)		 34,486 women age 55-69, from the general population of Iowa women; 242 incident coronary deaths; follow-up virtually complete (used National Death Index) at 7 years. Incident coronary death, in Q4 (>250 IU/day) vs. Q1 (non-users). Age, total energy intake,body mass index, waist-to-hip ratio, pack year of smoking, hypertension, diabetes, oral contraceptive use, estrogen replacement therapy, physical activity, alcohol intake, marital status, education.     1.09
(0.67-1.77)		    
Q5 (>1000 mg/day) vs. Q1 (non-users). Same as above.   0.74
(0.30-1.83)		      
Q4 (>10,000 IU/day) vs. Q1 (non-users). Same as above. 1.29
(0.70-2.39)		        
NHANES I Epidemiologic Follow-up Study
Enstrom, 199222
(Good)		 11,348 men (39%) and women age 25-74. Representative sample of the noninstitutionalized U.S. population 92% (in women) to 94% (in men) follow-up at 10 years. Cardiovascular mortality; Standardized mortality ratio of regular supplement users. Adjusted to standardized US population using SUDAAN.   0.52
(0.39-0.69)		      
All-cause mortality; Standardized mortality ratio of regular supplement users Adjusted to standardized US population using SUDAAN   0.74
(0.62-0.88)		      
Established Populations for Epidemiologic Studies of the Elderly
Losonczy, 199623
(Good)		 11,178 men and women in 4 communities > age 65; 1101 coronary disease deaths; follow-up rate for mortality virtually complete (used National Death Index) at 6 years. Coronary disease mortality in users vs. non-users. Age, sex, race, education, alcohol use, smoking history, aspirin use, coronary heart disease, stroke, diabetes, cancer, hypertension, and body mass index.   0.99
(0.74-1.33)		 0.59
(0.37-0.93)		 0.52
(0.28-0.97)		 1.11
(0.91-1.36)
All-cause mortality, in users vs. non-users. Age, sex, race, education, alcohol use, smoking history, aspirin use, coronary heart disease, stroke, diabetes, cancer, hypertension, and body mass index.   1.09
(0.93-1.28)		 0.73
(0.58-0.91)		 0.63
(0.46-0.86)		 1.03
(0.91-1.16)
Rotterdam Study
Klipstein-Grobusch, 199924
(Good)		 4802 residents of one district in the Netherlands age 55-95, 173 myocardial infarctions; 94% follow-up rate at mean 4 years (range 3-7 years). Incident fatal and non-fatal myocardial infarction, in users vs. non-users. Adjusted; unclear for which variables.       0.49
(0.21-0.99)		  
Cancer Prevention Study II
Watkins, 200025
(Fair)		 1,063,023 US residents recruited by American Cancer Society volunteers, follow-up virtually complete (used National Death Index) at 7 years. Cardiovascular mortality, in users vs. non-users. Age, race, marital status, body mass index, smoking, employment, exercise, education, aspirin use, diuretic use, liquor, wine, beer, or coffee consumption, vegetable index, history of diabetes, hypertension, heart disease, stroke, estrogen use.       Men: 0.94
(0.88-1.01)
Women: 0.90
(0.82-0.99)		 Men: 0.99
(0.93-1.06)
Women: 0.97
(0.90-1.05)
All-cause mortality, in users vs. non-users. All of the above plus cancer, kidney disease, cirrhosis.       Men: 0.98
(0.96-1.01)
Women: 0.95
(0.92-0.98)		 Men: 1.05
(1.02-1.08)
Women: 1.02
(1.00-1.05)
Finnish Mobile Clinic Study
Knekt, 199426
(Good)		 5133 men and women in Finland age 30-69, free of known heart disease at baseline; 244 coronary heart disease deaths; 100% follow-up at mean 14 years (range 12-16 years). Cardiovascular mortality: users of supplements containing vitamin E and/or C vs. non-users. Age, smoking, cholesterol, hypertension, body mass index, energy intake.       0.55
(0.18-1.73)		  
Physicians' Health Study Screening Cohort
Muntwyler, 200227
(Good)		 83,639 male physicians who responded to a letter inviting participation in Physicians' Health Study, with no history of cardiovascular disease. Follow-up virtually complete (National Death Index) at 4 years. Cardiovascular (CVD) and coronary heart (CHD) disease mortality, in user and non-users. History of hypertension, history of hypercholesterolemia, current and past smoking, alcohol intake, physical activity, body mass intake, complimentary vitamins, randomization status.   CVD Mortality:
0.88
(0.70-1.12)
CHD Mortality:
0.86
(0.63-1.18)		 CVD Mortality:
0.92
(0.70-1.21)
CHD Mortality:
0.88
(0.61-1.27)		   CVD Mortality:
1.07
(0.91-1.25)
CHD Mortality:
1.02
(0.83-1.25)
Cholesterol Lowering Atherosclerosis Study
Hodis, 199528
(Good)		 Analysis of secondary prevention in randomized clinical trial of patients with repeat angiography at 2 years. Study compares coronary artery disease progression with aggressive cholesterol reduction vs. placebo. This cohort analysis uses assessed supplemental vitamin use. Change in minimal lumenal diameter assessed 2 years apart in supplement users (Vitamin E> 100 IU/day, Vitamin C> 250 mg/day) and the obverse. Unadjusted.   No difference in progression of stenosis in users. Significantly less progression of stenosis in users (P=0.04).    

Note: CABG indicates coronary artery bypass grafting; CHD, coronary heart disease; MI, myocardial infarction; NHANES, National Health and Nutrition Examination Survey.
* Quetelet index is a measure of body mass index.

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