Multivitamins in the prevention of cancer and cardiovascular disease: The COSMOS randomized clinical trial
Mené aux Etats-Unis entre 2015 et 2020 sur 21 442 personnes âgées d'au moins 60 ans (durée médiane de suivi : 3,6 ans), cet essai randomisé analyse le rôle, dans la prévention des cancers, d'une supplémentation en vitamines et minéraux
Although older adults commonly take multivitamin-multimineral (MVM) supplements to promote health, evidence on use of daily MVMs on invasive cancer is limited.The study objective was to determine if a daily MVM decreases total invasive cancer among older adults.We performed a randomized, double-blind, placebo-controlled, two-by-two factorial trial of a daily MVM and cocoa extract for prevention of cancer and cardiovascular disease (CVD) among 21,442 U.S. adults (12,666 women aged ≥ 65 years and 8776 men aged ≥ 60 years) free of major CVD and recently diagnosed cancer. The intervention phase was from June 2015 through December 2020. This article reports on the MVM intervention.Participants were randomly assigned to daily MVM or placebo. The primary outcome was total invasive cancer, excluding non-melanoma skin cancer. Secondary outcomes included major site-specific cancers, total CVD, all-cause mortality, and total cancer risk among those with a baseline history of cancer.During a median follow-up of 3.6 years, invasive cancer occurred in 518 participants in the MVM group and 535 participants in the placebo group (hazard ratio [HR]=0.97, 95% confidence interval [CI]: 0.86, 1.09; P = 0.57). We observed no significant effect of a daily MVM on breast cancer (HR = 1.06, 95% CI: 0.79, 1.42) or colorectal cancer (HR = 1.30, 95% CI: 0.80, 2.12). We observed a protective effect of a daily MVM on lung cancer (HR = 0.62, 95% CI: 0.42, 0.92). The composite CVD outcome occurred in 429 participants in the MVM group and 437 participants in the placebo group (HR = 0.98, 95% CI: 0.86, 1.12). MVM did not significantly affect all-cause mortality (HR = 0.93; 95% CI: 0.81,1.08). There were no safety concerns.A daily MVM supplement, compared with placebo, did not significantly reduce the incidence of total cancer among older men and women. Future studies are needed to determine the effects of MVMs on other aging-related outcomes among older adults.