Nutrient supplements and cardiovascular disease: a heartbreaking story

Abstract

Observational data have identified associations between carotenoids, folic acid, and vitamin E, or metabolites altered by these nutrients, and cardiovascular disease (CVD) risk. Despite biological plausibility, for the most part, data derived from nutrient supplement trials using moderate to high doses of single nutrients or nutrient combinations (exceeding amounts to avoid nutrient deficiency) have been disappointing. The data for vitamin D is not yet adequate to evaluate; observational data suggest were a relationship to exist it would be related to nutrient insufficiency. There is some evidence that use of nutrient supplements intended to decrease CVD risk has resulted in unanticipated adverse consequences. Potential discrepancies between observational and interventional data include concerns of residual confounding by diet and lifestyle patterns, publication bias against studies with null or negative outcomes, reliance on secondary rather than primary prevention trials, and unaccounted for contribution of genotypic variations. At this time there are insufficient data to recommend the routine use of nutrient supplements to prevent or treat CVD. In the recent past we have learned a great deal about anticipated and unanticipated consequences of nutrient supplementation and cardiovascular outcomes. As a result, we are in a better position to adjudicate new potential relationships as data emerge.-Lichtenstein, A. H. Nutrient supplements and cardiovascular disease: a heartbreaking story. J. Lipid Res. 2009. 50: S429-S433. Supplementary key words CVDHope springs eternal that a single or combination nutrient supplement will be identified to dramatically reduce cardiovascular disease (CVD) risk and will require no more dietary restraint or physical exertion than the quick sideward twist of the wrist (open container) and front hand bend (insert pill in mouth). The evidence to date, however, has yet to identify a nutrient supplement meeting these criteria and, in some cases, raises concern regarding unintended adverse consequences. This mini-review provides a short synopsis of the topic. It is limited to essential nutrients. The order of presentation is arranged alphabetically. CAROTENOIDSA number of retrospective and prospective longitudinal studies have identified an inverse association between carotenoid intake or plasma/serum concentrations and CVD risk (as reviewed in Ref. 1). The biological mechanism for these associations has been attributed to the antioxidant potential of carotenoids (2).Results from a series of intervention trials using bcarotene supplements, the major dietary carotenoid, have not supported the hypothesis that b-carotene reduces CVD risk (as reviewed in Refs. 1, 3). It is not clear why there is a discrepancy between the observational and interventional data; nor is it possible to determine whether the putative factor(s) in the observational studies was the b-carotene, other carotenoids, or phytochemicals occurring in the same foods as carotenoids (fruits and vegetables), or dietary pa...

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