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In the news: Long-term Multi Use Lowers CVD Risk; Retinal Vessel Caliber Marks CVD Risk

Long-term Daily Multi Use Lowers CVD Risk

Few prospective studies have investigated the association of daily multivitamin and mineral (multi) supplements with the long- and short-term risks of cardiovascular disease (CVD). The findings from two studies that have examined this relationship are instructive.

The first, a Harvard study published in 2012, found no benefit of daily multi use among US male physicians followed for about a decade (1). Now, the same researchers report that among those initially healthy physicians, multi use for 20 years or more is associated with a significant reduction in major CVD events (2): A 44% reduced risk of heart attacks or strokes, and a 14% lower risk of needing cardiac revascularization (stents and/or cardiac surgery).

In the new research, the Harvard team studied 18,530 male physicians aged 40 years and older from the Physicians' Health Study I cohort who were free of CVD and cancer at baseline. All men provided a wide range of self-reported lifestyle and clinical factors plus intake of selected foods and dietary supplements. Cox proportional hazards models were used to calculate multivariable-adjusted hazard ratios (95% confidence intervals).

As with the earlier investigation, no risk reduction was observed in the first 10 years of following these men, who were on average under 50 years of age at baseline. Cardiovascular benefits did not become apparent until daily multi use reached the duration of 20 or more years.

According to Michael Roizen, MD Chair of the Cleveland Clinic Wellness Institute and Chief Wellness Officer of the Cleveland Clinic, these two differing study results make sense since most heart attacks and strokes occur after age 60; it takes cardiovascular events happening to assess prevention of those events (3).“ Today, there is substantial evidence of benefits for long-term multvitamin use for supporting overall wellness and reducing the risk of various illnesses, including cardiovascular disease,” Dr. Roizen opined.

Retinal Vessel Caliber is a Marker for CVD Risk

Wider retinal venules (very small veins that collect blood from capillaries), and narrower retinal arterioles (branches of an artery that lead into capillaries), have been associated with negative cardiovascular (CV) outcomes in the past.

In a new study, Harvard researchers looked at whether retinal vessel calibers (determined by retinal photography) are linked with cardiovascular outcomes over the long-term, and compared these measures against the American Heart Association’s pooled cohort equation (PCE) in predicting CV events (4).

After following 10,470 participants of the Atherosclerosis Risk in Communities Study for a mean 16 years, a significant association was found between wider retinal vessels or narrower retinal arterioles and rate of ischemic stroke (p<0.0001 for both venules and arterioles) and death (p<0.001 for venules and p=0.02 for arterioles).

One intriguing finding was that in women, but not men, these retinal vessel features were associated with higher rates of coronary heart disease (p=0.02). In fact, 21% of the women who were considered low risk by the PCE risk calculator would have been moved up to the intermediate risk category based on the retinal measures.

The retinal vasculature provides a unique window to assess vascular health noninvasively and directly, and this study validates the benefit of retinal vessel caliber measures for predicting the risk for ischemic stroke and mortality in the general population.

References

1. Sesso HD, et al. Multivitamins in the prevention of cardiovascular disease in men: the Physicians Health Study II randomized controlled trial. JAMA 308:1751-60, 2012.
2. Rautiainen S, et al. Multivitamin use and the risk of cardiovascular disease in men. J Nutr 146:1235-40, 2016.
3. www.nutri-facts.org. Expert Opinion: Using Science to Make Sense of Contradictory Multi-Vitamin Headlines. Michael Roizen, MD. Sept. 12, 2016.
4. Seidelmann SB, et al. Retinal vessel calibers in predicting long-term cardiovascular outcomes: The Atherosclerosis Risk in Communities Study. Circulation [EPub, Sept. 28, 12016].