Effects of Nutritional Supplements and Dietary Interventions on Cardiovascular Outcomes
Authors: Martin Mayer
Journal: Annals of Internal Medicine (2020)

Letters7 January 2020Effects of Nutritional Supplements and Dietary Interventions on Cardiovascular OutcomesMartin Mayer, DMSc, MS, PA-CMartin Mayer, DMSc, MS, PA-CEBSCO Health and Triad Hospitalist Group, Cone Health, Greensboro, North Carolina (M.M.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L19-0715 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:I applaud Khan and colleagues (1) for taking on the substantial task of performing an umbrella review on nutritional supplements and dietary interventions on cardiovascular outcomes. However, their results for salt reduction for the outcome of all-cause mortality in patients without hypertension deserve additional scrutiny. They cite a Cochrane review (2) as the sole source for this outcome, and the number of events and participants are consistent with that review's analysis for all-cause mortality at longest follow-up.The RR point estimates in both the Cochrane review and Khan and colleagues' review are 0.90, but the CIs differ ...References1. Khan SU, Khan MU, Riaz H, et al. Effects of nutritional supplements and dietary interventions on cardiovascular outcomes: an umbrella review and evidence map. Ann Intern Med. 2019;171:190-8. [PMID: 31284304]. doi:10.7326/M19-0341 LinkGoogle Scholar2. Adler AJ, Taylor F, Martin N, et al. Reduced dietary salt for the prevention of cardiovascular disease. Cochrane Database Syst Rev. 2014:CD009217. [PMID: 25519688] doi:10.1002/14651858.CD009217.pub3 CrossrefMedlineGoogle Scholar3. Wiksten A, Rücker G, Schwarzer G. Hartung–Knapp method is not always conservative compared with fixed-effect meta-analysis. Stat Med. 2016;35:2503-15. [PMID: 26842654] doi:10.1002/sim.6879 CrossrefMedlineGoogle Scholar4. Jackson D, Law M, Rücker G, et al. The Hartung–Knapp modification for random-effects meta-analysis: a useful refinement but are there any residual concerns? Stat Med. 2017;36:3923-34. [PMID: 28748567] doi:10.1002/sim.7411 CrossrefMedlineGoogle Scholar5. Patel CJ, Burford B, Ioannidis JP. Assessment of vibration of effects due to model specification can demonstrate the instability of observational associations. J Clin Epidemiol. 2015;68:1046-58. [PMID: 26279400] doi:10.1016/j.jclinepi.2015.05.029 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: EBSCO Health and Triad Hospitalist Group, Cone Health, Greensboro, North Carolina (M.M.)Disclosures: The author has disclosed no conflicts of interest. The form can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L19-0715. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoEffects of Nutritional Supplements and Dietary Interventions on Cardiovascular Outcomes 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 Effects of Nutritional Supplements and Dietary Interventions on Cardiovascular Outcomes John E. Cornell and Cynthia D. Mulrow Effects of Nutritional Supplements and Dietary Interventions on Cardiovascular Outcomes Jesper M. Kivelä Metrics 7 January 2020Volume 172, Issue 1Page: 74KeywordsConflicts of interestDisclosureHypertensionMortalityNutritionSaltsStatistical data ePublished: 7 January 2020 Issue Published: 7 January 2020 Copyright & PermissionsCopyright © 2020 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...