Multivitamin Use and Risk of Cancer and Cardiovascular Disease in the Women's Health Initiative Cohorts
Multivitamin Use and Risk of Cancer and Cardiovascular Disease in the Women's Health Initiative Cohorts
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DOI：
10.1001/archinternmed.2008.540
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发表时间：
2009-02-09
影响因子：
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通讯作者：
Prentice, Ross L.
中科院分区：
文献类型：
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作者：
Neuhouser, Marian L.;Wassertheil-Smoller, Sylvia;Prentice, Ross L.
背景资料：数以百万计的绝经后妇女使用多种维生素，通常认为补充剂可以预防癌症和心血管疾病（CVD）等慢性疾病。因此，我们决定研究多种维生素的使用和癌症，心血管疾病和死亡率之间的关联在绝经后women.Methods：该研究包括161 808名参与者从妇女健康倡议临床试验（N = 68 132在3重叠试验激素治疗，饮食调整，钙和维生素D补充剂）或观察性研究（N = 93 676）。在基线和随访时间点收集复合维生素使用的详细数据。研究招募发生在1993年至1998年之间;临床试验中女性随访中位数为8.0年，观察性研究中为7.9年。收集了2005年的疾病终点。我们记录了乳腺癌（浸润性），结肠/直肠癌，子宫内膜癌，肾癌，膀胱癌，胃癌，卵巢癌和肺癌; CVD（心肌梗死，中风和静脉血栓栓塞）;和总死亡率。在临床试验队列中位随访8.0年和观察性研究队列中位随访7.9年后，报告了9619例乳腺癌、结直肠癌、子宫内膜癌、肾癌、膀胱癌、胃癌、肺癌或卵巢癌; 8751例CVD事件; 9865例死亡。多变量校正分析显示，多种维生素的使用与癌症风险无关（乳腺癌的风险比[HR]，0.98，95%置信区间[CI]，0.91-1.05;结直肠癌的风险比[HR]，0.99，95% CI，0.88-1.11;子宫内膜癌的风险比[HR]，1.05，95% CI，0.90-1.21;肺癌的HR，1.0和95%CI，0.88-1.13;卵巢癌的HR，1.07和95%CI，0.88-1.29）; CVD（心肌梗死的HR，0.96和95%CI，0.89-1.03;卒中的HR，0.99和95%CI，0.91-1.07;静脉血栓栓塞的HR，1.05和95%CI，0.85-1.29）;结论：在临床试验和观察性研究队列中分别进行了8.0年和7.9年的中位随访后，妇女健康倡议研究提供了令人信服的证据，证明多种维生素的使用对绝经后妇女的常见癌症、心血管疾病或总死亡率的风险影响很小或没有影响。
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 (myocardial 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.