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Evidence for Supplement Use to Prevent Cancer or Cardiovascular Disease?

December 4th, 2013

By Tirhas Mekonnen, PharmD Student, Cedarville University

Dietary supplements have been used for various reasons. Dietary supplements such as ascorbate, vitamin E, and ß-carotene, are reducing agents and thereby, detoxify reactive oxygen intermediates in the laboratory.1 Researchers are studying to find out if consumption of food rich in these antioxidant compounds could potentially reduce the risk for certain types of cancers as well as other chronic health problems like cardiovascular disease.  However, clinical trials with antioxidants as dietary supplements have failed to show clear beneficial effects.1

This article on Medpage Today by Todd Neale discussed a systematic review that investigated the use of mineral and dietary supplementation for primary prevention of cardiovascular disease or cancer.2 The review evaluates 24 randomized, controlled trials and 2 cohort studies that examined the benefits and harms of using vitamin and mineral supplements for primary prevention of CVD, cancer, or all-cause mortality in healthy individuals without known nutritional deficiencies.3 The study found that except for two clinical trials, there was only “a small borderline-significant benefit” from multivitamin supplements on cancer (but only in men), limited evidence supports any benefit from vitamin and mineral supplementation for the prevention of cancer or cardiovascular disease”.3 Although the review looked at many studies there are some limitations.

One of the limitations is that the review included short term studies that analyze the use of dietary supplements.3 However, those short-term studies may not confirm or indicate the outcomes of chronic use of dietary supplements. For example, the median follow up time of the study titled, “Randomized, placebo-controlled trial of the health effects of antioxidant vitamins and minerals” was only for seven and half years.4 The review also consists of studies done in various countries. However, poor eating habits, tobacco use, consumption of alcohol, and many other variables may differ from one country to the other country.  These variables are risk factors for chronic heart disease or cancer.

Other sources have also not found consistent evidence to recommend minerals and dietary supplements for the primary prevention of cardiovascular disease and cancer.  An article titled “Nutrient supplements and cardiovascular disease” discussed associations between carotenoids, folic acid, and vitamin E with CVD risk.5 As the article illustrated, previous researchers thought that vitamin E, due to its antioxidant effect, may reduce CVD. However, the article also noted more recent randomized placebo-controlled interventional trials do not support the original assumption regarding vitamin E.5 The article also pointed out that “With few exceptions, a large series of primary and secondary prevention trials have reported no significant benefit of moderate-to high-dose vitamin E supplementation of cardiovascular outcomes”.5

In addition, the use of dietary supplement folate and its association with cardiovascular health benefit was discussed in another review article by Ulrich and Potter et al. This article also is consistent with the previous reviews and studies mentioned above. “The prevention of cardiovascular disease was assumed to be another health benefit of increased folate intake; unfortunately, the results from randomized controlled trials with actual disease outcomes provide no evidence for such an effect.”6 Therefore, there is currently a lack of evidence to suggest that folate prevents cardiovascular disease or cancer.

In conclusion, after reading these reviews and studies, I agree with Mr. Todd Neale, that there is no clear answer for the following question: Is there clear evidence to recommend minerals and dietary supplements for the primary prevention of cardiovascular disease?  I would like to get your professional opinion on this matter. Please participate if you have found studies that do have a better explanation as to whether to recommend or to not recommend dietary supplements for the primary prevention of cardiovascular disease or cancer.

References

  1. Harvey R, Ferrier D. Lippincott’s illustrated Reviews. 6th ed. Wolters Kluwer Health, Philadelphia, PA/Lipincott Williams & Wilkins; 2011.
  2. Neale T. USPSTF: Evidence for Supplement Use Lacking. Medpage Today. Published: Nov 11, 2013 Retrieved from http://www.medpagetoday.com/Cardiology/Prevention/42842?xid=nl_mpt_DHE_2013-11-12&eun=g388495d0r&userid=388495&email=dr.usman23@gmail.com&mu_id=5381424
  3. Fortmann S, Burda B, Senger C, Lin J, Whitlock E. Vitamin and Mineral Supplements in the Primary Prevention of Cardiovascular Disease and Cancer: An Updated Systematic Evidence Review for the U.S. Preventive Services Task Force. Annals of Internal Medicine. 2013; published on-line doi:10.7326/0003-4819-159-12-201312170-00729. 
  4. Hercberg S, Galan P, Preziosi P, Bertrais S, Mennen L, Malvy D, et al. The SU.VI.MAX Study: a randomized, placebo-controlled trial of the health effects of antioxidant vitamins and minerals. Arch Intern Med. 2004;164(21):2335-42. [PMID: 15557412]
  5. Lichtenstein A. Nutrient supplements and cardiovascular disease: a heartbreaking story. J. Lipid Res. 200; 50:(S429-S433).Available from: http://www.jlr.org/content/50/Supplement/S429.full
  6. Ulrich M, Potter J. Folate Supplementation: Too Much of a Good Thing? Cancer Epidemiology Biomakers & Prevention Feb 2006;15:189. Retrieved from http://cebp.aacrjournals.org/content/15/2/189.full

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4 Responses to “Evidence for Supplement Use to Prevent Cancer or Cardiovascular Disease?”

  1. Anna Smith Says:

    You did a great job at presenting the information and making a case as to why you agree with the news article. I have to agree with you that there is no clear evidence to recommend these dietary supplements for the primary prevention of cardiovascular disease. Although taking these supplements may benefit an individual, they do not seem to have a strong enough impact on cardiovascular disease. Other supplements that were not mentioned or researched within these studies may provide many benefits to heart health. Even if other supplements were found to help reduce risk of cardiovascular disease and provide many benefits for the heart, I still think that supplements should not be recommended as primary prevention. There should be other methods taken into account to prevent cardiovascular disease, especially since supplements like these are not tightly regulated like prescription medications.

    I do think this information was very interesting, though. It also mentioned being beneficial to decrease the risk of cancer, which I would like to know more about. Dietary supplements could provide many benefits, but people do need to be cautious when trying to self-treat for diseases that should be assessed by doctors. This could be very harmful and possibly fatal. I think supplements can affect diseases and health in many different ways that have yet to be explored, but I also think researchers should continue to study the adverse effects of supplements as well so that people do not receive biased information.

  2. Olumami Amaye Says:

    This is very interesting article, you actually touch on the dietary supplement. First I think it is important to understand that dietary supplements are not intended to be a medication substitute because they cannot replicate cancer or CVD drugs. Many supplements contain active ingredients that have strong biological effects in the body. This could make them unsafe and in some situations can hurt or complicate one’s health. For example, using supplements with medications, substituting supplements for prescription medicines, and taking too much of some supplements can lead to harmful and even life threatening consequences. However, there are only a limited number of studies for most individual nutrients, and differences in study designs make it difficult to pool effects across supplements,” according to the draft recommendations. “Therefore, the USPSTF is not able to conclude with certainty that there is no effect.

    I also agree with you that no clear answer to your question: Is there clear evidence to recommend minerals and dietary supplements for the primary prevention of cardiovascular disease? They can be very confusing which is why learning everything you can from dietary supplements is a must before you buy, or before you use them. There are many different mineral and dietary supplements out there each with their own beneficial outcomes. Dietary supplements like any other drugs have beneficial and harmful side effects. They are a very tricky supplement and people need to be careful when using them and although I have said it many times throughout my blog assignment you must talk to your doctor before using them. This is because dietary supplements don’t react well with certain prescription drugs, or people with certain problems.

  3. Yevgeniy A Solokha Says:

    I personally don’t think that minerals and dietary supplements should be used for the primary prevention of cardiovascular disease because they are not regulated by the FDA. Therefore, it is hard to judge their efficacy. Also, not all of the dietary supplements are equivalent, since they can be derived in different ways. This greatly contributes to their variability. I believe that the best way to prevent cardiovascular disease is to maintain a healthy diet and lifestyle along with a consistent exercise routine.

  4. Elizabeth Ledbetter Says:

    I agree with Yevgeniy that these dietary supplements should not be used as primary treatment for CVD. First, as he mentioned, these supplements are not regulated by the FDA in the same way that prescription and OTC drugs are regulated. Dietary supplements may be kept on the shelves until enough adverse events are reported to take them down. Because of this, I don’t believe they are a safe and effective primary treatment recommendation. I would feel the need to do a lot more research on supplements before recommending them to my patients, even as a secondary option for prevention.

    I think that you did a great job conveying the information from the studies you researched, and ultimately concluding that there is still more research to be done! I think for now, the most appropriate recommendation we can make to our patients to reduce the risk of CVD is lifestyle changes. Diet and exercise have so many benefits, and I would always recommend those two options before a supplement or even a prescription medication.

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