title: Multivitamin use and cardiovascular disease in a prospective study of women.
abstract: BACKGROUND
  Although multivitamins are widely used, there are limited prospective studies investigating their association with both long- and short-term risk of cardiovascular disease (CVD).
  
  
  OBJECTIVE
  The objective was to investigate how multivitamin use is associated with the long- and short-term risk of CVD.
  
  
  METHODS
  A prospective cohort study was conducted of 37,193 women from the Women's Health Study aged ≥45 y and free of CVD and cancer at baseline who were followed for an average of 16.2 y. At baseline, women self-reported a wide range of lifestyle, clinical, and dietary factors. Women were categorized into 1) no current use and 2) current use of multivitamins. Duration and updated measures over the course of the follow-up to address short-term effects were also considered. Women were followed for major CVD events, including myocardial infarction (MI), stroke, and CVD death.
  
  
  RESULTS
  During the follow-up, 1493 incident cases of CVD [defined as myocardial infarction (MI), stroke, and CVD death] occurred. In multivariable analyses, multivitamin use compared with no use was not associated with major CVD events (HR: 1.01; 95% CI: 0.89, 1.15), MI (HR: 1.04; 95% CI: 0.84, 1.27), stroke (HR: 0.99; 95% CI: 0.83, 1.18), or CVD death (HR: 1.10; 95% CI: 0.84, 1.45). A nonsignificant inverse association was observed between baseline multivitamin use and major CVD events among women aged ≥70 y (P-interaction = 0.04) and those consuming <3 servings/d of fruit and vegetables (P-interaction = 0.01). When updating information on multivitamin use during the course of follow-up, no associations were observed for major CVD events (HR: 0.91; 95% CI: 0.82, 1.02), MI (HR: 0.89; 95% CI: 0.74, 1.06), stroke (HR: 0.91; 95% CI: 0.78, 1.06), and CVD death (HR: 0.91; 95% CI: 0.71, 1.16).
  
  
  CONCLUSIONS
  In this study of middle-aged and elderly women, neither baseline nor time-varying multivitamin use was associated with the long-term risk of major CVD events, MI, stroke, cardiac revascularizations, or CVD death. Additional studies are needed to clarify the role of multivitamins on CVD.
authors.affiliation: From the Department of Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden (SR); the Divisions of Preventive Medicine (SR, I-ML, PMR, JMG, JEM, JEB, and HDS) and Aging (JMG and HDS), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA); the Departments of Social and Behavioral Science (PMR) and Epidemiology (I-ML, PMR, JEM, JEB, and HDS), Harvard School of Public Health, Boston, MA; and the VA Boston Healthcare System, Boston, MA (JMG).
authors.forename: Susanne
authors.initials: S
authors.lastname: Rautiainen
authors.affiliation: From the Department of Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden (SR); the Divisions of Preventive Medicine (SR, I-ML, PMR, JMG, JEM, JEB, and HDS) and Aging (JMG and HDS), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA); the Departments of Social and Behavioral Science (PMR) and Epidemiology (I-ML, PMR, JEM, JEB, and HDS), Harvard School of Public Health, Boston, MA; and the VA Boston Healthcare System, Boston, MA (JMG).
authors.forename: I-Min
authors.initials: IM
authors.lastname: Lee
authors.affiliation: From the Department of Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden (SR); the Divisions of Preventive Medicine (SR, I-ML, PMR, JMG, JEM, JEB, and HDS) and Aging (JMG and HDS), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA); the Departments of Social and Behavioral Science (PMR) and Epidemiology (I-ML, PMR, JEM, JEB, and HDS), Harvard School of Public Health, Boston, MA; and the VA Boston Healthcare System, Boston, MA (JMG).
authors.forename: Pamela M
authors.initials: PM
authors.lastname: Rist
authors.affiliation: From the Department of Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden (SR); the Divisions of Preventive Medicine (SR, I-ML, PMR, JMG, JEM, JEB, and HDS) and Aging (JMG and HDS), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA); the Departments of Social and Behavioral Science (PMR) and Epidemiology (I-ML, PMR, JEM, JEB, and HDS), Harvard School of Public Health, Boston, MA; and the VA Boston Healthcare System, Boston, MA (JMG).
authors.forename: J Michael
authors.initials: JM
authors.lastname: Gaziano
authors.affiliation: From the Department of Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden (SR); the Divisions of Preventive Medicine (SR, I-ML, PMR, JMG, JEM, JEB, and HDS) and Aging (JMG and HDS), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA); the Departments of Social and Behavioral Science (PMR) and Epidemiology (I-ML, PMR, JEM, JEB, and HDS), Harvard School of Public Health, Boston, MA; and the VA Boston Healthcare System, Boston, MA (JMG).
authors.forename: JoAnn E
authors.initials: JE
authors.lastname: Manson
authors.affiliation: From the Department of Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden (SR); the Divisions of Preventive Medicine (SR, I-ML, PMR, JMG, JEM, JEB, and HDS) and Aging (JMG and HDS), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA); the Departments of Social and Behavioral Science (PMR) and Epidemiology (I-ML, PMR, JEM, JEB, and HDS), Harvard School of Public Health, Boston, MA; and the VA Boston Healthcare System, Boston, MA (JMG).
authors.forename: Julie E
authors.initials: JE
authors.lastname: Buring
authors.affiliation: From the Department of Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden (SR); the Divisions of Preventive Medicine (SR, I-ML, PMR, JMG, JEM, JEB, and HDS) and Aging (JMG and HDS), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA); the Departments of Social and Behavioral Science (PMR) and Epidemiology (I-ML, PMR, JEM, JEB, and HDS), Harvard School of Public Health, Boston, MA; and the VA Boston Healthcare System, Boston, MA (JMG).
authors.forename: Howard D
authors.initials: HD
authors.lastname: Sesso
mesh_terms: D005260:Female; D006801:Humans; D008875:Middle Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000401:mortality / Q000517:prevention & control; D015331:Cohort Studies; D019587:Dietary Supplements; D005500:Follow-Up Studies; D006282:Health Personnel; D015994:Incidence; D009203:Myocardial Infarction / Q000453:epidemiology / Q000401:mortality / Q000517:prevention & control; D016016:Proportional Hazards Models; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology / Q000401:mortality / Q000517:prevention & control; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology; D014815:Vitamins / Q000627:therapeutic use
chemical_list: D014815:Vitamins
keywords: cardiovascular disease; cohort; dietary supplements; epidemiology; multivitamin