Cardiovascular disease (CVD) is a major cause of morbidity/mortality world-wide, hence preventive interventions are crucial. Observational data showing beneficial CV effects of vitamin supplements, promoted by self-proclaimed experts, have led to ~50% of Americans using multivitamins; this practice has culminated into a multi-billion-dollar business. However, robust evidence is lacking, and certain vitamins might incur harm. This two-part review focuses on the attributes or concerns about specific vitamin consumption on CVD. The evidence for indiscriminate use of multivitamins indicates no consistent CVD benefit. Specific vitamins and/or combinations are suggested, but further supportive evidence is needed. Data presented in Part 1 indicated that folic acid and certain B-vitamins may decrease stroke, whereas niacin might raise mortality; beta-carotene mediates pro-oxidant effects, which may abate the benefits from other vitamins. In Part 2, data favor the anti-oxidant effects of vitamin C and the anti-atherogenic effects of vitamins C and E, but clinical evidence is inconsistent. Vitamin D may provide CV protection, but data are conflicting. Vitamin K appears neutral. Thus, there are favorable CV effects of individual vitamins (C/D), but randomized/controlled data are lacking. An important caveat regards the potential toxicity of increased doses of fat-soluble vitamins (A/D/E/K). As emphasized in Part 1, vitamins might benefit subjects who are antioxidant-deficient or exposed to high levels of oxidative-stress (e.g., diabetics, smokers, and elderly), stressing the importance of targeting certain subgroups for optimal results. Finally, by promoting CV-healthy balanced-diets, we could acquire essential vitamins and nutrients and use supplements only for specific indications.

中文翻译：

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维生素在心血管健康中的作用：了解您的事实 - 第 2 部分

心血管疾病（CVD）是全世界发病/死亡的主要原因，因此预防干预至关重要。观察数据显示维生素补充剂对心血管有益，在自称专家的推动下，约 50% 的美国人开始使用多种维生素；这种做法最终形成了一项价值数十亿美元的业务。然而，缺乏强有力的证据，某些维生素可能会造成损害。这篇由两部分组成的综述重点关注 CVD 中特定维生素消耗的属性或担忧。滥用多种维生素的证据表明，并没有一致的 CVD 益处。建议使用特定的维生素和/或组合，但需要进一步的支持证据。第 1 部分中提供的数据表明，叶酸和某些 B 族维生素可能会减少中风，而烟酸可能会增加死亡率；β-胡萝卜素介导促氧化作用，这可能会减弱其他维生素的益处。在第 2 部分中，数据支持维生素 C 的抗氧化作用以及维生素 C 和 E 的抗动脉粥样硬化作用，但临床证据不一致。维生素 D 可能提供心血管保护，但数据相互矛盾。维生素 K 呈中性。因此，单个维生素 (C/D) 具有良好的 CV 效应，但缺乏随机/对照数据。一个重要的警告是增加脂溶性维生素 (A/D/E/K) 剂量的潜在毒性。正如第 1 部分所强调的，维生素可能有益于抗氧化剂缺乏或暴露于高水平氧化应激的受试者（例如糖尿病患者、吸烟者和老年人），强调针对某些亚组以获得最佳结果的重要性。最后，通过促进有利于心血管健康的均衡饮食，我们可以获得必需的维生素和营养素，并仅针对特定适应症使用补充剂。