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The Medical Letter on Drugs and Therapeutics
FROM
ISSUE
1379
December 12, 2011
View Complete Issue         Table of Contents 2011 
Who Should Take Vitamin Supplements?
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December 12, 2011 (Issue: 1379)
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Revised 1/25/12: The first paragraph on vitamin E has been revised.

Many patients ask their healthcare providers whether they should take vitamins. Since the last Medical Letter article on this subject,1 more data have become available on the benefits and risks of taking vitamins.

VITAMIN E — Vitamin E in food or supplements acts as an antioxidant, but under some conditions may have a pro-oxidant effect.2 High doses of vitamin E may interfere with vitamin K metabolism and platelet function.

Effect on Mortality – A meta-analysis of 26 clinical trials including 105,065 subjects found that supplementation with vitamin E alone or in combination with beta-carotene and vitamin A was associated with an increased risk of death.3

Pregnancy – A meta-analysis of 9 trials involving 19,810 pregnant women found that vitamin E and ... more       Show References Hide References

1. Vitamin Supplements. Med Lett Drugs Ther 2005; 47:57.

2. Office of Dietary Supplements. National Institutes of Health. Dietary supplement fact sheet: vitamin E. Available at http://ods.od.nih.gov/factsheets/vitaminE. Accessed November 30, 2011.

3. G Bjelakovic et al. Antioxidant supplements for prevention of mortality in healthy participants and patients with various diseases (review). Cochrane Database Syst Rev 2008; 2:CD007176.

4. A Conde-Agudelo et al. Supplementation with vitamins C and E during pregnancy for the prevention of preeclampsia and other adverse maternal and perinatal outcomes: a systematic review and metaanalysis. Am J Obstet Gynecol 2011; 204:503.

5. JM Roberts et al. Vitamins C and E to prevent complications of pregnancy-associated hypertension. N Engl J Med 2010; 362:1282.

6. Q Bin et al. The role of vitamin E (tocopherol) supplementation in the prevention of stroke: a meta-analysis of 13 randomised controlled trials. Thromb Haemost 2011; 105:579.

7. M Schürks et al. Effects of vitamin E on stroke subtypes: metaanalysis of randomised controlled trials. BMJ 2010; 341:c5702.

8. HD Sesso et al. Vitamins E and C in the prevention of cardiovascular disease in men: the Physicians’ Health Study II randomized controlled trial. JAMA 2008; 300:2123.

9. IM Lee et al. Vitamin E in the primary prevention of cardiovascular disease and cancer: the Women’s Health Study: a randomized controlled trial. JAMA 2005; 294:56.

10. J Lin et al. Vitamins C and E and beta carotene supplementation and cancer risk: a randomized controlled trial. J Natl Cancer Inst 2009; 101:14.

11. EA Klein et al. Vitamin E and the risk of prostate cancer; the Selenium and Vitamin E Cancer Prevention Trial (SELECT). JAMA 2011; 306:1549.

12. GS Omenn et al. Effects of a combination of beta carotene and vitamin A on lung cancer and cardiovascular disease. N Engl J Med 1996; 334:1150.

13. J Virtamo et al. Incidence of cancer and mortality following alpha-tocopherol and beta-carotene supplementation: a postintervention follow-up. JAMA 2003; 290:476.

14. AM Mondul et al. Serum retinol and risk of prostate cancer. Am J Epidemiol 2011; 173:813.

15. In brief: calcium and vitamin D supplements. Med Lett Drugs Ther 2006; 48:61.

16. Drugs for postmenopausal osteoporosis. Treat Guidel Med Lett 2011; 9:67.

17. HA Bischoff-Ferrari et al. Fracture prevention with vitamin D supplementation: a meta-analysis of randomized controlled trials. JAMA 2005; 293:2257.

18. BM Tang et al. Use of calcium or calcium in combination with vitamin D supplementation to prevent fractures and bone loss in people aged 50 years and older: a meta-analysis. Lancet 2007; 370:657.

19. KM Sanders et al. Annual high-dose oral vitamin D and falls and fractures in older women: a randomized controlled trial. JAMA 2010; 303:1815.

20. JM Gaziano et al. Vitamins E and C in the prevention of prostate and total cancer in men: the Physicians’ Health Study II randomized controlled trial. JAMA 2009; 301:52.

21. RM Douglas et al. Vitamin C for preventing and treating the common cold. Cochrane Database Syst Rev 2007; (3):CD000980.

22. In brief: Vitamin B12 nasal spray. Med Lett Drugs Ther 2005; 47:64.

23. Folic acid supplementation to prevent neural tube defects. Med Lett Drugs Ther 2004; 46:17.

24. CM Albert et al. Effect of folic acid and B vitamins on risk of cardiovascular events and total mortality among women at high risk for cardiovascular disease: a randomized trial. JAMA 2008; 299:2027.

25. JF Toole et al. Lowering homocysteine in patients with ischemic stroke to prevent recurrent stroke, myocardial infarction, and death: the Vitamin Intervention for Stroke Prevention (VISP) randomized controlled trial. JAMA 2004; 291:565.

26. M Ebbing et al. Combined analyses and extended follow-up of two randomized controlled homocysteine-lowering B-vitamin trials. J Intern Med 2010; 268:367.

27. SC Larsson et al. Vitamin B6 and risk of colorectal cancer: a meta-analysis of prospective studies. JAMA 2010: 303:1077.

28. M Ebbing et al. Cancer incidence and mortality after treatment with folic acid and vitamin B12. JAMA 2009; 302:2119.

29. J Mursu et al. Dietary supplements and mortality rate in older women; the Iowa Women’s Health Study. Arch Intern Med 2011; 171:1625.

30. SP Donadelli et al. Daily vitamin supplementation and hypovitaminosis after obesity surgery. Nutrition 2011 Nov 3 (epub).

31. P Shankar et al. Micronutrient deficiencies after bariatric surgery. Nutrition 2010; 26:1031.

The Medical Letter is a subscriber-funded nonprofit organization that publishes critical appraisals of new prescription drugs and comparative reviews of drugs for common diseases.

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