Vitamins and Supplements The use of vitamin supplementation is a widespread prac- tice in the general population that amounts to tremendous expenditure. Many benefits have been attributed to the use of vitamin supplements, particularly those touted to have protective effects against cardiovascular disease and stroke. Observational studies have suggested that some vitamin supplements can reduce adverse cardiovascular events. For example, in the prospective Nurses Health Study of >80000 participants, women who voluntarily reported taking vitamin C and vitamin E supplements were noted to have a lower risk of developing CAD over more than a decade of follow-up.417,418 However, large, randomized, controlled studies of vitamins have not demonstrated such benefits in a variety of general and high-risk populations. The Physicians Health Study II was a randomized, double-blind, placebo-controlled trial of vitamin C and vitamin E supplementation that enrolled 14641 US male physicians 50 years of age. In this study, neither vitamin C nor vitamin E supplements reduced the risk of major cardiovascular events, even after more than a decade of treatment and follow-up.419,420 Among 12064 MI survivors, a placebo-controlled trial demonstrated that supplementation with folic acid and vitamin B12 also did not have beneficial effects on cardiovascular outcomes.421 This was confirmed in a meta-analysis of >37000 participants that demonstrated that high-dose B vitamins and folic acid are not effective as a secondary prevention measure for cardiovascular disease.422 Finally, a meta-analysis of 50 randomized, controlled trials with nearly 300000 participants showed no benefit of vitamin and antioxidant supplementation in reducing the risk of major cardiovascular events, including subgroup meta-analyses examining the effects of individual vitamins.423 Undergoing cardiac surgery leads to considerable stress on the body, which plays a key factor in determining outcome. 