Multivitamin nudges up cardio function in older adults

Clinical Takeaway: A daily multivitamin modestly preserved heart-related function over three years in adults 60 and older, with clinically meaningful gains found in those with carotid stenosis.

Multivitamins are a daily habit for millions of older Americans, and most clinicians shrug when asked whether they help. A new analysis gives that conversation a firmer footing by measuring what patients care about most: symptoms and the ability to dress, walk, climb stairs, and get through daily chores. The multivitamin moved those scores, though not by much.

Supplement trials have mostly judged multivitamins on disease endpoints, and prior analysis of this dataset itself previously found no effect on cardiovascular events. This secondary analysis turned instead to a patient-reported measure of heart-related symptom burden and physical ability.

After three years, the multivitamin group scored 0.63 points better on symptom burden and 0.43 points better on the overall clinical summary than placebo, on a 100-point scale where a 5-point change is roughly the smallest difference a patient would notice. In other words, the average effect was real but too small to perceive.

The exception was in the 122 participants with carotid stenosis, whose 7.58-point gain is the kind of difference that shows up in daily life. Cocoa extract, the trial's other intervention, did nothing for the group as a whole; only in heart failure did it move the needle, with 238 participants gaining 5.62 points on symptom burden.

The findings come from COSMOS, a randomized, double-blind, placebo-controlled trial that assigned 21,442 US adults (men 60 and older, women 65 and older) without major cardiovascular disease to a daily multivitamin, cocoa extract, both, or placebo. This analysis covered the 16,027 participants who completed the Kansas City Cardiomyopathy Questionnaire annually for three years. The results were presented at NUTRITION 2026 and have not yet been peer reviewed.

The practical read for generally healthy older adults is modest: a low-risk habit with little functional payoff to promise. But the two meaningful subgroup effects both appeared where perfusion was already impaired, a clustering consistent with a vascular mechanism, particularly for cocoa flavanols and their established endothelial effects.

"What makes this work unique is our focus on functional health, how people actually feel and function in their daily lives," said Bayu B. Bekele, PhD, of the Georgia Prevention Institute, Medical College of Georgia at Augusta University.

Source: Dong Y, et al. (2026 Jul 27) NUTRITION 2026. Multivitamin-Mineral Supplementation Modestly Improves Cardiovascular-Related Functional Health Status in Older Adults: Secondary Findings From the COSMOS Trial