{"id":27942,"date":"2025-05-07T04:18:00","date_gmt":"2025-05-06T20:18:00","guid":{"rendered":"https:\/\/csccm.org.cn\/?p=27942"},"modified":"2025-05-07T05:56:06","modified_gmt":"2025-05-06T21:56:06","slug":"jama-intern-med%e5%8f%91%e8%a1%a8%e8%ae%ba%e6%96%87%ef%bc%9a%e7%b3%96%e5%b0%bf%e7%97%85%e6%82%a3%e8%80%85%e5%bf%83%e8%82%8c%e6%a2%97%e5%a1%9e%e5%90%8e%e6%9c%8d%e7%94%a8%e5%a4%9a%e7%a7%8d%e7%bb%b4","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=27942","title":{"rendered":"[JAMA Intern Med\u53d1\u8868\u8bba\u6587]\uff1a\u7cd6\u5c3f\u75c5\u60a3\u8005\u5fc3\u808c\u6897\u585e\u540e\u670d\u7528\u591a\u79cd\u7ef4\u751f\u7d20"},"content":{"rendered":"\n

Original Investigation <\/p>\n\n\n\n

March 3, 2025<\/p>\n\n\n\n

Multivitamins After Myocardial Infarction in Patients With Diabetes: A Randomized Clinical Trial<\/h1>\n\n\n\n

Francisco Ujueta, Gervasio A. Lamas, Kevin J. Anstrom, et al<\/h3>\n\n\n\n

JAMA Intern Med. <\/em>Published online March 3, 2025. doi:10.1001\/jamainternmed.2024.8408<\/h3>\n\n\n\n

Key Points<\/p>\n\n\n\n

Question<\/strong>  In participants with diabetes and prior myocardial infarction (MI), do oral multivitamins and multiminerals (OMVMs), with or without edetate disodium (EDTA)-based chelation, reduce major adverse cardiovascular events compared to placebo OMVM?<\/p>\n\n\n\n

Findings<\/strong>  In this randomized clinical trial of 1000 participants with diabetes and prior MI, the findings of the initial Trial to Assess Chelation Therapy were confirmed in this patient population. OMVM did not reduce major adverse cardiovascular events compared to placebo OMVM, with or without with active EDTA-based chelation.<\/p>\n\n\n\n

Meaning<\/strong>  In participants with diabetes and prior MI, high-dose OMVMs alone or in conjunction with EDTA-based chelation did not reduce cardiovascular events.<\/a><\/p>\n\n\n\n

Abstract<\/p>\n\n\n\n

Importance<\/strong>  In 2013, the Trial to Assess Chelation Therapy (TACT) reported that in 1708 patients with stable coronary disease and prior myocardial infarction (MI), oral multivitamins and multiminerals (OMVMs), in a factorial design with edetate disodium (EDTA) chelation therapy, did not reduce cardiovascular events relative to placebo OMVMs, but active EDTA combined with active OMVMs was superior to placebo OMVM\/placebo EDTA.<\/p>\n\n\n\n

Objective<\/strong>  To compare OMVM vs placebo in terms of efficacy for reducing major adverse cardiovascular events in patients with diabetes and prior MI.<\/p>\n\n\n\n

Design, Setting, and Participants<\/strong>  The TACT2 randomized, multicenter double-masked 2\u2009\u00d7\u20092 factorial clinical trial took place across 88 sites in the US and Canada. Participants were 50 years or older, had diabetes, and had an MI 6 weeks ago or more. TACT2 participants were enrolled between September 2016 and December 2020. Data were collected between October 2016 and June 2023.<\/p>\n\n\n\n

Interventions<\/strong>  Six caplets daily of a 28 component OMVM or matching OMVM placebo, and 40 weekly infusions of an EDTA-based chelation solution or matching placebo, in a 1:1:1:1 allocation ratio.<\/p>\n\n\n\n

Main Outcomes and Measures<\/strong>  The primary end point was the composite of all-cause mortality, MI, stroke, coronary revascularization, or hospitalization for unstable angina.<\/p>\n\n\n\n

Results<\/strong>\u00a0\u00a0A total of 1000 participants were randomized (500 in the active OMVM group and 500 in the placebo group). The median (IQR) age was 67 (60-72) years, and 730 (73%) were male. Median (IQR) follow-up was 48 (34-58) months. The primary end point occurred in 175 participants (35%) in the active OMVM group and 175 (35%) in the placebo group (hazard ratio [HR], 0.99 [95% CI, 0.80-1.22];\u00a0P<\/em>\u2009=\u2009.92). The 5-year event rate for the primary end point in the EDTA chelation\u2009+\u2009active OMVM group was 34.0%; in the EDTA chelation\u2009+\u2009placebo OMVM group, 35.7%; in the placebo infusion\u2009+\u2009active OMVM group, 36.0%; and in the placebo infusion\u2009+\u2009placebo OMVM group, 34.3%. The comparison of the active infusion\u2009+\u2009active OMVM with the placebo infusion\u2009+\u2009placebo OMVM was not significant (HR, 0.91 [95% CI, 0.67-1.23];\u00a0P<\/em>\u2009=\u2009.54). Although nonsignificant, there was a numerically higher event rate of MI, stroke, mortality from cardiovascular causes in the active OMVM compared to placebo OMVM group.<\/p>\n\n\n\n

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Conclusions and Relevance<\/strong>  The results of this randomized clinical trial demonstrated that, for participants with chronic coronary disease, diabetes, and a previous MI, high-dose OMVM alone or in conjunction with EDTA-based chelation did not reduce cardiovascular events.<\/p>\n\n\n\n

Trial Registration<\/strong>  ClinicalTrials.gov Identifier: NCT02733185<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

Original Investigation  March 3, 2025 Mu […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/27942"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=27942"}],"version-history":[{"count":2,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/27942\/revisions"}],"predecessor-version":[{"id":28243,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/27942\/revisions\/28243"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=27942"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=27942"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=27942"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}