How to Avoid a Heart Attack: Putting It All Together -Journal of the American Osteopathic Association

Note: this is not specific to treatment-related cardiovascular concerns

Conclusion
The central question posed in the letter to the editor by Juhl et al2 is whether supplements of vitamins E and C and the B vitamins have demonstrated an evidence-based reduction in patients' cardiovascular risk. Unfortunately, the authors' criticism of the perceived deficiencies of a previously published study1 does not constitute evidence to support their position; it serves only to point out those perceived flaws.

Multiple meta-analyses and reviews of published medical literature have convincingly established that there are few, if any, objective, evidence-based, well-designed trials to support the use of supplements of vitamins E or C or those in the B family to reduce risk of cardiovascular events. Furthermore, I am unaware of any study that advocates the use of these supplements to help patients or to rejuvenate our ailing medical delivery system.

If Dr Juhl and his coauthors2 seek to establish the medical value of these supplements, I would recommend that they design, participate in, and publish a study to establish their yet unproven hypothesis. Until such a goal is accomplished, my opinion (shared by researchers at the Mayo Clinic,3 the Cleveland Clinic,5 the AHRQ,12 and the American Heart Association19) is that published evidence clearly does not support the use of vitamins E, C, B6, B9, or B12 to improve patients' cardiovascular health.