CARDIOVASCULAR DISEASE (CVD) IS THE MAJOR CAUSE of death and disability globally and affects more than 50% of men and 40% of women during their lifetimes. Despite remarkable scientific advances, in 2008 CVD accounted for 1 of every 3 deaths in the United States and for health care costs estimated at close to $300 billion. The major risk factors for CVD are well known but remain ubiquitous in populations. For example, about one-third of US adults ( 75 million) have hypertension; more than 20% smoke; more than one-third ( 78 million) are obese; 8% ( 18 million) have diagnosed diabetes, with similar rates of undiagnosed diabetes and an additional 35% with prediabetes; 15% have high cholesterol levels; and, in the 2009-2010 NHANES survey, 46.5% (102.5 million) had at least 1 major risk factor among uncontrolled blood pressure, high cholesterol levels, and current smoking. These risk factors are also major contributors to other chronic diseases such as cancer, depression, arthritis, kidney disease, and cognitive decline. Strategies to prevent the development of these risk factors, which are largely related to lifestyle habits, and effective therapies to lower risk factor levels when these are present, can lead to substantial reductions in the burden of CVD. The sources of unfavorable lifestyle habits are largely known, and therapies that can effectively and safely lower levels of risk factors have been identified and extensively tested. Yet the apparently simple task of implementing this knowledge grounded in decades of sound research continues to remain extremely challenging and seems at times insurmountable. Thus, even though CVD mortality rates have declined greatly in the United States and other developed countries, the disease burden remains high, and the progress that has been made is threatened by increasing rates of obesity, physical inactivity, and diabetes. Furthermore, urbanization, profound lifestyle changes, and a decline in competing risks for premature death have resulted in substantial increases in CVD in developing countries. Numerous factors account for the current failure to achieve optimal results in CVD prevention, including (1) low adoption and adherence to healthy lifestyles and to proven, inexpensive, and safe pharmacological therapies, even when prescribed using sound evidence and to persons at highest risk; (2) the complexity of implementing meaningful lifestyle intervention programs, which require not only behavioral interventions to modify individual lifestyles but also changes in health policy, the environment, and cultural attitudes; and (3) the cost and affordability of implementing meaningful lifestyle modification programs and of using proven drugs when necessary. Many individuals and societies as a whole resort to the use of vitamins and other dietary supplements as a simple and miraculous escape from the difficult and complex task of implementing effective prevention strategies. Most required vitamins and micronutrients can generally be derived from a healthy, well-balanced diet. In addition, many food products are already fortified with folic acid, vitamin D, calcium, fluoride, and other micronutrients, which may be needed in higher amounts by some individuals or may not be readily available to others (eg, infants, pregnant women, postmenopausal women with low exposure to sunlight, or those living in poverty). However, despite the lack of solid evidence for benefit from the widespread use of vitamins and dietary supplements, more than half of US adults take at least 1 dietary supplement (about 10% take 5 such supplements), and these numbers continue to increase; 32% of the US population used at least 1 dietary supplement in the 1970s, 42% in 19881994, and 53% in 2003-2006. Moreover, such dietary supplements are used more frequently by healthier, more educated and affluent people—those at lowest risk for dietary deficiencies. Multivitamins/multiminerals are by far the most frequently used dietary supplement; 30% of the US population used them in 1988-1994 and 39% in 2003-2006. Regulations governing the approval and marketing of dietary supplements remain less strict than those for prescription or even over-the counter drugs and do not mandate conclusive proof of benefit or safety based on large randomized controlled clinical trials (RCTs). This has allowed for claims of benefit in preventing or curing an amazingly diverse and
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