• Safi U Khan, Muhammad U Khan, Haris Riaz, Shahul Valavoor, Di Zhao, Lauren Vaughan, Victor Okunrintemi, Irbaz Bin Riaz, Muhammad Shahzeb Khan, Edo Kaluski, M Hassan Murad, Michael J Blaha, Eliseo Guallar, and Erin D Michos.
• West Virginia University, Morgantown, West Virginia (S.U.K., M.U.K., S.V.).
• Ann. Intern. Med. 2019 Aug 6; 171 (3): 190-198.

BackgroundThe role of nutritional supplements and dietary interventions in preventing mortality and cardiovascular disease (CVD) outcomes is unclear.PurposeTo examine evidence about the effects of nutritional supplements and dietary interventions on mortality and cardiovascular outcomes in adults.Data SourcesPubMed, CINAHL, and the Cochrane Library from inception until March 2019; ClinicalTrials.gov (10 March 2019); journal Web sites; and reference lists.Study SelectionEnglish-language, randomized controlled trials (RCTs) and meta-analyses of RCTs that assessed the effects of nutritional supplements or dietary interventions on all-cause mortality or cardiovascular outcomes, such as death, myocardial infarction, stroke, and coronary heart disease.Data ExtractionTwo independent investigators abstracted data, assessed the quality of evidence, and rated the certainty of evidence.Data SynthesisNine systematic reviews and 4 new RCTs were selected that encompassed a total of 277 trials, 24 interventions, and 992 129 participants. A total of 105 meta-analyses were generated. There was moderate-certainty evidence that reduced salt intake decreased the risk for all-cause mortality in normotensive participants (risk ratio [RR], 0.90 [95% CI, 0.85 to 0.95]) and cardiovascular mortality in hypertensive participants (RR, 0.67 [CI, 0.46 to 0.99]). Low-certainty evidence showed that omega-3 long-chain polyunsaturated fatty acid (LC-PUFA) was associated with reduced risk for myocardial infarction (RR, 0.92 [CI, 0.85 to 0.99]) and coronary heart disease (RR, 0.93 [CI, 0.89 to 0.98]). Folic acid was associated with lower risk for stroke (RR, 0.80 [CI, 0.67 to 0.96]; low certainty), whereas calcium plus vitamin D increased the risk for stroke (RR, 1.17 [CI, 1.05 to 1.30]; moderate certainty). Other nutritional supplements, such as vitamin B6, vitamin A, multivitamins, antioxidants, and iron and dietary interventions, such as reduced fat intake, had no significant effect on mortality or cardiovascular disease outcomes (very low- to moderate-certainty evidence).LimitationsSuboptimal quality and certainty of evidence.ConclusionReduced salt intake, omega-3 LC-PUFA use, and folate supplementation could reduce risk for some cardiovascular outcomes in adults. Combined calcium plus vitamin D might increase risk for stroke.Primary Funding SourceNone.

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