Multivitamin use and risk of cancer and cardiovascular disease in the women's health initiative cohorts

Marian L. Neuhouser, Sylvia Wassertheil-Smoller, Cynthia Thomson, Aaron Aragaki, Garnet L. Anderson, Joann E. Manson, Ruth E. Patterson, Thomas E. Rohan, Linda Van Horn, James M. Shikany, Asha Thomas, Andrea Lacroix, Ross L. Prentice

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Abstract

Background: Millions of postmenopausal women use multivitamins, often believing that supplements prevent chronic diseases such as cancer and cardiovascular disease (CVD). Therefore, we decided to examine associations between multivitamin use and risk of cancer, CVD, and mortality in postmenopausal women. Methods: The study included 161 808 participants from the Women's Health Initiative clinical trials (N = 68 132 in 3 overlapping trials of hormone therapy, dietary modification, and calcium and vitamin D supplements) or an observational study (N = 93 676). Detailed data were collected on multivitamin use at baseline and follow-up time points. Study enrollment occurred between 1993 and 1998; the women were followed up for a median of 8.0 years in the clinical trials and 7.9 years in the observational study. Disease end points were collected through 2005. We documented cancers of the breast (invasive), colon/rectum, endometrium, kidney, bladder, stomach, ovary, and lung; CVD (myocar- dial infarction, stroke, and venous thromboembolism); and total mortality. Results: A total of 41.5% of the participants used multivitamins. After a median of 8.0 years of follow-up in the clinical trial cohort and 7.9 years in the observational study cohort, 9619 cases of breast, colorectal, endometrial, renal, bladder, stomach, lung, or ovarian cancer; 8751 CVD events; and 9865 deaths were reported. Multivariate- adjusted analyses revealed no association of multivitamin use with risk of cancer (hazard ratio [HR], 0.98, and 95% confidence interval [CI], 0.91-1.05 for breast cancer; HR, 0.99, and 95% CI, 0.88-1.11 for colorectal cancer; HR, 1.05, and 95% CI, 0.90-1.21 for endometrial cancer; HR, 1.0, and 95% CI, 0.88-1.13 for lung cancer; and HR, 1.07, and 95% CI, 0.88-1.29 for ovarian cancer); CVD (HR, 0.96, and 95% CI, 0.89-1.03 for myocardial infarction; HR, 0.99, and 95% CI, 0.91-1.07 for stroke; and HR, 1.05, and 95% CI, 0.85-1.29 for venous thromboembolism); or mortality (HR, 1.02, and 95% CI, 0.97-1.07). Conclusion: After a median follow-up of 8.0 and 7.9 years in the clinical trial and observational study cohorts, respectively, the Women's Health Initiative study provided convincing evidence that multivitamin use has little or no influence on the risk of common cancers, CVD, or total mortality in postmenopausal women. Trial Registration: clinicaltrials.gov Identifier: NCT00000611

Original languageEnglish (US)
Pages (from-to)294-304
Number of pages11
JournalArchives of Internal Medicine
Volume169
Issue number3
DOIs
StatePublished - Feb 9 2009

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Women's Health
Cardiovascular Diseases
Confidence Intervals
Neoplasms
Observational Studies
Clinical Trials
Mortality
Venous Thromboembolism
Ovarian Neoplasms
Lung Neoplasms
Urinary Bladder
Stroke
Myocardial Infarction
Breast Neoplasms
Diet Therapy
Kidney
Dietary Calcium
Endometrial Neoplasms
Endometrium
Rectum

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Neuhouser, M. L., Wassertheil-Smoller, S., Thomson, C., Aragaki, A., Anderson, G. L., Manson, J. E., ... Prentice, R. L. (2009). Multivitamin use and risk of cancer and cardiovascular disease in the women's health initiative cohorts. Archives of Internal Medicine, 169(3), 294-304. https://doi.org/10.1001/archinternmed.2008.540

Multivitamin use and risk of cancer and cardiovascular disease in the women's health initiative cohorts. / Neuhouser, Marian L.; Wassertheil-Smoller, Sylvia; Thomson, Cynthia; Aragaki, Aaron; Anderson, Garnet L.; Manson, Joann E.; Patterson, Ruth E.; Rohan, Thomas E.; Van Horn, Linda; Shikany, James M.; Thomas, Asha; Lacroix, Andrea; Prentice, Ross L.

In: Archives of Internal Medicine, Vol. 169, No. 3, 09.02.2009, p. 294-304.

Research output: Contribution to journalArticle

Neuhouser, ML, Wassertheil-Smoller, S, Thomson, C, Aragaki, A, Anderson, GL, Manson, JE, Patterson, RE, Rohan, TE, Van Horn, L, Shikany, JM, Thomas, A, Lacroix, A & Prentice, RL 2009, 'Multivitamin use and risk of cancer and cardiovascular disease in the women's health initiative cohorts', Archives of Internal Medicine, vol. 169, no. 3, pp. 294-304. https://doi.org/10.1001/archinternmed.2008.540
Neuhouser, Marian L. ; Wassertheil-Smoller, Sylvia ; Thomson, Cynthia ; Aragaki, Aaron ; Anderson, Garnet L. ; Manson, Joann E. ; Patterson, Ruth E. ; Rohan, Thomas E. ; Van Horn, Linda ; Shikany, James M. ; Thomas, Asha ; Lacroix, Andrea ; Prentice, Ross L. / Multivitamin use and risk of cancer and cardiovascular disease in the women's health initiative cohorts. In: Archives of Internal Medicine. 2009 ; Vol. 169, No. 3. pp. 294-304.
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abstract = "Background: Millions of postmenopausal women use multivitamins, often believing that supplements prevent chronic diseases such as cancer and cardiovascular disease (CVD). Therefore, we decided to examine associations between multivitamin use and risk of cancer, CVD, and mortality in postmenopausal women. Methods: The study included 161 808 participants from the Women's Health Initiative clinical trials (N = 68 132 in 3 overlapping trials of hormone therapy, dietary modification, and calcium and vitamin D supplements) or an observational study (N = 93 676). Detailed data were collected on multivitamin use at baseline and follow-up time points. Study enrollment occurred between 1993 and 1998; the women were followed up for a median of 8.0 years in the clinical trials and 7.9 years in the observational study. Disease end points were collected through 2005. We documented cancers of the breast (invasive), colon/rectum, endometrium, kidney, bladder, stomach, ovary, and lung; CVD (myocar- dial infarction, stroke, and venous thromboembolism); and total mortality. Results: A total of 41.5{\%} of the participants used multivitamins. After a median of 8.0 years of follow-up in the clinical trial cohort and 7.9 years in the observational study cohort, 9619 cases of breast, colorectal, endometrial, renal, bladder, stomach, lung, or ovarian cancer; 8751 CVD events; and 9865 deaths were reported. Multivariate- adjusted analyses revealed no association of multivitamin use with risk of cancer (hazard ratio [HR], 0.98, and 95{\%} confidence interval [CI], 0.91-1.05 for breast cancer; HR, 0.99, and 95{\%} CI, 0.88-1.11 for colorectal cancer; HR, 1.05, and 95{\%} CI, 0.90-1.21 for endometrial cancer; HR, 1.0, and 95{\%} CI, 0.88-1.13 for lung cancer; and HR, 1.07, and 95{\%} CI, 0.88-1.29 for ovarian cancer); CVD (HR, 0.96, and 95{\%} CI, 0.89-1.03 for myocardial infarction; HR, 0.99, and 95{\%} CI, 0.91-1.07 for stroke; and HR, 1.05, and 95{\%} CI, 0.85-1.29 for venous thromboembolism); or mortality (HR, 1.02, and 95{\%} CI, 0.97-1.07). Conclusion: After a median follow-up of 8.0 and 7.9 years in the clinical trial and observational study cohorts, respectively, the Women's Health Initiative study provided convincing evidence that multivitamin use has little or no influence on the risk of common cancers, CVD, or total mortality in postmenopausal women. Trial Registration: clinicaltrials.gov Identifier: NCT00000611",
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T1 - Multivitamin use and risk of cancer and cardiovascular disease in the women's health initiative cohorts

AU - Neuhouser, Marian L.

AU - Wassertheil-Smoller, Sylvia

AU - Thomson, Cynthia

AU - Aragaki, Aaron

AU - Anderson, Garnet L.

AU - Manson, Joann E.

AU - Patterson, Ruth E.

AU - Rohan, Thomas E.

AU - Van Horn, Linda

AU - Shikany, James M.

AU - Thomas, Asha

AU - Lacroix, Andrea

AU - Prentice, Ross L.

PY - 2009/2/9

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N2 - Background: Millions of postmenopausal women use multivitamins, often believing that supplements prevent chronic diseases such as cancer and cardiovascular disease (CVD). Therefore, we decided to examine associations between multivitamin use and risk of cancer, CVD, and mortality in postmenopausal women. Methods: The study included 161 808 participants from the Women's Health Initiative clinical trials (N = 68 132 in 3 overlapping trials of hormone therapy, dietary modification, and calcium and vitamin D supplements) or an observational study (N = 93 676). Detailed data were collected on multivitamin use at baseline and follow-up time points. Study enrollment occurred between 1993 and 1998; the women were followed up for a median of 8.0 years in the clinical trials and 7.9 years in the observational study. Disease end points were collected through 2005. We documented cancers of the breast (invasive), colon/rectum, endometrium, kidney, bladder, stomach, ovary, and lung; CVD (myocar- dial infarction, stroke, and venous thromboembolism); and total mortality. Results: A total of 41.5% of the participants used multivitamins. After a median of 8.0 years of follow-up in the clinical trial cohort and 7.9 years in the observational study cohort, 9619 cases of breast, colorectal, endometrial, renal, bladder, stomach, lung, or ovarian cancer; 8751 CVD events; and 9865 deaths were reported. Multivariate- adjusted analyses revealed no association of multivitamin use with risk of cancer (hazard ratio [HR], 0.98, and 95% confidence interval [CI], 0.91-1.05 for breast cancer; HR, 0.99, and 95% CI, 0.88-1.11 for colorectal cancer; HR, 1.05, and 95% CI, 0.90-1.21 for endometrial cancer; HR, 1.0, and 95% CI, 0.88-1.13 for lung cancer; and HR, 1.07, and 95% CI, 0.88-1.29 for ovarian cancer); CVD (HR, 0.96, and 95% CI, 0.89-1.03 for myocardial infarction; HR, 0.99, and 95% CI, 0.91-1.07 for stroke; and HR, 1.05, and 95% CI, 0.85-1.29 for venous thromboembolism); or mortality (HR, 1.02, and 95% CI, 0.97-1.07). Conclusion: After a median follow-up of 8.0 and 7.9 years in the clinical trial and observational study cohorts, respectively, the Women's Health Initiative study provided convincing evidence that multivitamin use has little or no influence on the risk of common cancers, CVD, or total mortality in postmenopausal women. Trial Registration: clinicaltrials.gov Identifier: NCT00000611

AB - Background: Millions of postmenopausal women use multivitamins, often believing that supplements prevent chronic diseases such as cancer and cardiovascular disease (CVD). Therefore, we decided to examine associations between multivitamin use and risk of cancer, CVD, and mortality in postmenopausal women. Methods: The study included 161 808 participants from the Women's Health Initiative clinical trials (N = 68 132 in 3 overlapping trials of hormone therapy, dietary modification, and calcium and vitamin D supplements) or an observational study (N = 93 676). Detailed data were collected on multivitamin use at baseline and follow-up time points. Study enrollment occurred between 1993 and 1998; the women were followed up for a median of 8.0 years in the clinical trials and 7.9 years in the observational study. Disease end points were collected through 2005. We documented cancers of the breast (invasive), colon/rectum, endometrium, kidney, bladder, stomach, ovary, and lung; CVD (myocar- dial infarction, stroke, and venous thromboembolism); and total mortality. Results: A total of 41.5% of the participants used multivitamins. After a median of 8.0 years of follow-up in the clinical trial cohort and 7.9 years in the observational study cohort, 9619 cases of breast, colorectal, endometrial, renal, bladder, stomach, lung, or ovarian cancer; 8751 CVD events; and 9865 deaths were reported. Multivariate- adjusted analyses revealed no association of multivitamin use with risk of cancer (hazard ratio [HR], 0.98, and 95% confidence interval [CI], 0.91-1.05 for breast cancer; HR, 0.99, and 95% CI, 0.88-1.11 for colorectal cancer; HR, 1.05, and 95% CI, 0.90-1.21 for endometrial cancer; HR, 1.0, and 95% CI, 0.88-1.13 for lung cancer; and HR, 1.07, and 95% CI, 0.88-1.29 for ovarian cancer); CVD (HR, 0.96, and 95% CI, 0.89-1.03 for myocardial infarction; HR, 0.99, and 95% CI, 0.91-1.07 for stroke; and HR, 1.05, and 95% CI, 0.85-1.29 for venous thromboembolism); or mortality (HR, 1.02, and 95% CI, 0.97-1.07). Conclusion: After a median follow-up of 8.0 and 7.9 years in the clinical trial and observational study cohorts, respectively, the Women's Health Initiative study provided convincing evidence that multivitamin use has little or no influence on the risk of common cancers, CVD, or total mortality in postmenopausal women. Trial Registration: clinicaltrials.gov Identifier: NCT00000611

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