Multivitamin use and mortality in a large prospective study

To determine the relation between multivitamin use and death from heart dis ease, cerebrovascular disease, and cancer, the authors examined a prospecti ve cohort of 1,063,023 adult Americans in 1982-1989 and compared the mortal ity of users of multivitamins alone; vitamin A, C, or E alone; and multivit amin and vitamin A, C, or E in combination with that of vitamin nonusers by using multivariate Cox proportional hazard models. Multivitamin users had heart disease and cerebrovascular disease mortality risks similar to those of nonusers, whereas combination users had mortality risks that were 15% lo wer than those of nonusers. Multivitamin and combination use had minimal ef fect on cancer mortality overall, although mortality from all cancers combi ned was increased among male current smokers who used multivitamins alone ( relative risk (RR) = 1.13, 95% confidence interval (CI): 1.05, 1.23) or in combination with vitamin A, C, or E (RR = 1.16, 95% CI: 1.06, 1.26), but de creased in male combination users who had never (RR = 0.86, 95% CI: 0.74, 0 .99) or had formerly (RR = 0.90, 95% Cl: 0.82, 0.98) smoked. No such associ ations were seen in women. These observational data provide limited support for the hypothesis that multivitamin use in combination with vitamin A, C, or E may reduce heart disease and cardiovascular disease mortality, but ad d to concerns raised by randomized studies that some vitamin supplements ma y adversely affect male smokers.