In an attempt to obtain epidemiologic evidence regarding the mortality rate among vitamin supplement users, a prospective study was Only the cardiovascular SMR is significantly lower than 100%. The death rate for the males is approximately the same as that reported among other healthy nonsmoking questionnaire respondents, but the death rate for females is significantly less (P < 0.01). The only notable relationships between questions asked in 1974 and subsequent mortality are those indicating a higher mortality rate associated with inactivity, heart trouble, and very low and very high levels of vitamin E intake. For this highly selected cohort, the overall "Prevention life-style" appears to be a healthy one, but the cohort experiences no clear reduction in total mortality because of high levels of vitamin intake per se.Little reliable epidemiological information is available on the relationship between high levels of vitamin intake and mortality. The major prospective studies have concentrated on mortality in relation to factors such as tobacco consumption, alcohol consumption, serum cholesterol, some dietary habits, or other general health practices (1-4). One early study indicated that higher-than-average dietary intake of vitamins A and C was associated with a lower mortality rate (5). One recent study showed an inverse relationship between dietary vitamin A intake and lung cancer mortality but only a small nonsignificant inverse relationship with total mortality (6). Several other recent studies indicate that dietary vitamin A intake is inversely related to lung cancer and total cancer, and it has been suggested that vitamin A analogs may reduce cancer rates (7). None of these studies analyzed dietary supplements. It has been hypothesized that supplementary vitamin C may be beneficial in the prevention and treatment ofthe common cold (8) and cancer (9), although negative studies have been reported (10).The specific way in which vitamins may be causally related to cancer and other diseases is not clearly established. Nevertheless, the general public has shown great interest in this subject and the use ofvitamin supplements has grown dramatically in recent years. Recent estimates indicate that up to 50% of all adults in the United States now use vitamin supplements to some extent (4), in spite oflittle direct evidence as to their value. For this reason alone further scientific investigation is warranted. However, such investigation is complicated by the fact that this topic has become associated over the years with speculative and anecdotal claims and counterclaims. In addition, the people who use these supplements are often experimenting with various types and quantities ofvitamins as well as changing other aspects of their life-style. Consequently, it is difficult to conduct a properly controlled study.We selected Prevention readers because an existing 1974 questionnaire survey was made available to us. This magazine was founded in 1950 by J. I. Rodale and now has about 2.5 million subscribers, fa...