Most Vitamin, Mineral Supplements Not Shown To Lower Heart Disease Risk
Current research does not show enough evidence that vitamin or mineral supplements are beneficial for preventing or treating heart disease, with the exception of folic acid for reducing stroke risk.
But healthy diets that are heavy in plant-based foods from which these vitamins are derived naturally work.
That’s the gist of a review article published in the Journal of the American College of Cardiology.
Vitamins and minerals have long been used to treat nutrient deficiencies; however, in recent years supplements have been promoted as a means for overall health and longevity. According to the National Health and Nutrition Examination Survey, in 2012, it was estimated that 52% of the population were taking supplements.
Despite high use, there is no agreement on whether individual vitamins or minerals or combination supplements should be taken to prevent or treat heart disease. The U.S. Dietary Guidelines Advisory Committee recommend three diets to reduce heart disease risk: a healthy American diet low in saturated fat, trans fat and red meat, but high in fruit and vegetables; a Mediterranean diet; and a vegetarian diet.
In this review, researchers looked at 179 randomized controlled trials on vitamin and mineral supplement use published from January 2012 to October 2017 to determine if a benefit existed. This time frame includes papers published before and after the U.S. Preventive Services Task Force issued guidelines on the use of vitamins, minerals and multivitamins for primary prevention of cardiovascular disease and cancer in 2013.
Researchers found that data on the four most commonly used supplements–multivitamins, vitamin D, calcium and vitamin C–showed no consistent benefit for the prevention of cardiovascular disease, myocardial infarction or stroke, nor was there a benefit for all-cause mortality. Folic acid alone and B-complex vitamins in which folic acid was a component did show a reduction in stroke; however, niacin (vitamin B3) and antioxidants were associated with an increased risk of all-cause mortality.
These findings confirm the latest U.S. Preventive Services Task Force recommendation in 2014 that stated, “current evidence is insufficient to assess the balance of benefits and harms of single or paired nutrient supplements for the prevention of cardiovascular disease and cancer.”
The one exception seems to be the benefit of folic acid for stroke prevention. A 2015 publication from the China Stroke Primary Prevention Trial (CSPPT) study showed that folic acid supplements may reduce cardiovascular disease and stroke risk. The current JACC review also showed a 20% reduction in stroke with folic acid alone.
A May 7 JACC study from the CSPPT also showed hypertensive adults with low platelet count who took a daily pill of both enalapril and folic acid daily saw a 73% risk reduction in first stroke when compared to enalapril alone.
“Folic acid administration and the reduction of cardiovascular disease through stroke seen in the Chinese CSPPT trial provides the only example of cardiovascular disease risk reduction by supplement use in the period following the Preventive Services Task Recommendation,” said David J.A. Jenkins, MD, PhD, DSc, lead author of the review and professor and Canada research chair in nutrition and metabolism, Department of Nutritional Sciences, University of Toronto. “Whether these data are sufficient to change clinical practice in areas of the world where folic acid food fortification is already in place is still a matter for discussion.”
Limitations of the review include: the researchers did not consider data from cohort studies, which are longer and more representative of the general population than randomized clinical trials. Also, grouping many types of antioxidants may have been suboptimal since their mechanisms of action may also be very different.
Paramedic-Run Health Sessions in Low-Income Apartments Cut Number Of 911 Calls, Improved Health
A community-based health promotion program developed by McMaster University that was offered by paramedics in low-income apartment buildings significantly reduced the number of 911 calls and improved quality of life for seniors, found a randomized controlled trial published in CMAJ (Canadian Medical Association Journal)
Few studies exist on the impact of the new and rapidly evolving field of community paramedicine, which offers health care by paramedics outside of emergency visits.
Chronic diseases such as heart disease, diabetes and hypertension often cause older adults living at home to seek emergency care, leading to visits from paramedics. Seniors living in subsidized housing have higher death rates and poorer quality of life because of health issues.
The study looked at the impact of the Community Paramedicine at Clinic (CP@clinic), a weekly drop-in health promotion and prevention program for older adults run by trained paramedics in subsidized-housing buildings in Hamilton, Ontario. It compared buildings that received CP@clinic for one year, in addition to usual health care and wellness programs, with buildings that only received usual health care and nonparamedic wellness programs (control group). CP@clinic offers blood pressure, diabetes and falls assessments; identification of high-risk patients and referral to health care; health education and more. What sets this program apart from other paramedicine initiatives is the ongoing reports back to family doctors, who can reconnect with their patient.
In the buildings offering CP@clinic, there were significantly fewer emergency ambulance calls (3.1 calls per 100 units/month) compared with buildings that did not offer the clinics (3.99 calls 100 units/month), which translates to 22% fewer calls. The clinics picked up undiagnosed hypertension in 36 participants (52.5%) and elevated blood pressure in 75 people (54.7%) with previously diagnosed hypertension. After attending CP@clinic, mean blood pressure for participants with hypertension dropped significantly.
“The combination of risk factor improvements among participants were significant enough to show changes in participants’ diabetes risk category, which implies that CP@clinic is having an impact in reducing participants’ risk of developing diabetes,” says Dr. Gina Agarwal, Department of Family Medicine, McMaster University, Hamilton, Ontario. “As well, several health-related quality-of-life areas improved in those who attended, such as ability to perform daily tasks and personal care, suggesting that these overall improvements may have led to the reduction in calls in the intervention group compared with the controls.”
Building on its previous work, McMaster University ran the successful CP@clinic program with the Hamilton Paramedic Service in 2014 and 2015 in seniors’ social housing buildings. The program is still being run by the Hamilton Paramedic Service in the city.
“We estimate that an average of 10-11 calls per 10 apartment units could be avoided each year with programs like this,” says Dr. Agarwal. “We think that the difference in ambulance calls in the short term was due to improved health care access, linkage to health care resources and knowledge about when to access these services.”
Expanding the CP@clinic program into other subsidized housing buildings across Canada could improve the health of older adults and increase efficiencies in the health care system.
“The CP@clinic can reduce the burden on emergency services — saving resources for other important areas of health care,” she says.
“Because paramedics initiate care for people in their own homes and communities, these health care professionals are well placed to recognize the unmet needs of the community-dwelling individuals they serve and to act proactively to support efforts to stem unnecessary use of emergency medical services,” writes Michael Nolan, County of Renfrew, Ontario, with coauthors in a related commentary.
“The trial further highlights the potential value of deploying a low-cost community paramedicine intervention in a high-risk social-housing setting, because it showed a significant difference in the number of ambulance calls between participants who received the intervention (i.e., attending the CP@clinic) and controls,” write the authors.
The research study was funded by the Hamilton Academic Health Sciences Organization and the Canadian Institutes of Health Research (CIHR).
“Evaluation of a community paramedicine health promotion and lifestyle risk assessment program for older adults who live in social housing: a cluster randomized trial” is published May 28, 2018.