A daily multivitamin-mineral supplement modestly improved cardiovascular-related functional health in older adults over three years, according to a secondary analysis of the large COSMOS randomized clinical trial. The findings suggest that routine multivitamin use may help preserve day-to-day physical functioning as people age, particularly among those with certain preexisting cardiovascular conditions.
The research was presented July 27 at NUTRITION 2026, the annual meeting of the American Society for Nutrition.
The findings add to a growing body of evidence from the COSMOS trial suggesting that daily multivitamin supplementation may support healthy aging. Previous analyses reported modest improvements in cognitive function and slower biological aging, although multivitamins have not been shown to reduce major cardiovascular events.
The analysis included 16,027 participants from the COcoa Supplement and Multivitamin Outcomes Study (COSMOS), a randomized, double-blind, placebo-controlled trial that enrolled 21,442 U.S. adults without major cardiovascular disease at baseline. Men were at least 60 years old, and women were at least 65 years old when they entered the study.
Investigators evaluated participants’ responses to the Kansas City Cardiomyopathy Questionnaire (KCCQ), a validated patient-reported measure of cardiovascular health status. The questionnaire assesses physical function, symptom burden, and an overall clinical summary score reflecting the combined impact of both.
Participants assigned to receive a daily multivitamin experienced small but statistically significant improvements in symptom burden compared with those receiving placebo. While the supplements did not significantly improve physical ability scores overall, they produced a modest improvement in the overall clinical summary score.
“The results provide new evidence that a daily multivitamin modestly improved cardiovascular-related functional health, with more pronounced benefits in those with existing carotid stenosis,” the investigators concluded.
The largest benefits were seen in participants with carotid stenosis, a narrowing of the carotid arteries that increases the risk of stroke. Among the 122 participants with the condition, multivitamin supplementation produced clinically meaningful improvements in cardiovascular functional health scores, suggesting this subgroup may derive greater benefit than the broader study population.
The researchers noted that maintaining cardiovascular functional health has practical implications for older adults. Improvements in symptom burden may translate into greater ease performing everyday activities such as dressing, bathing, walking, climbing stairs, and completing household chores. Reduced fatigue, shortness of breath, and swelling could also help older adults remain active and independent.
The trial also evaluated cocoa extract supplementation, but it did not improve cardiovascular functional health in the study population overall. However, a subgroup analysis suggested cocoa extract helped preserve symptom burden scores among participants with heart failure, indicating that additional studies may be warranted in patients with established cardiovascular disease.
Unlike many nutrition studies that focus on disease prevention, this analysis examined how supplementation affected participants’ daily functioning and quality of life.
The investigators cautioned that the observed improvements with multivitamin use were modest and should not be viewed as a replacement for established healthy lifestyle measures such as maintaining a nutritious diet and engaging in regular physical activity.
Because this was a secondary analysis, the findings should be considered hypothesis-generating. The authors said future targeted clinical trials are needed to determine whether specific groups of older adults—particularly those with carotid stenosis or other cardiovascular conditions—may experience greater functional benefits from daily multivitamin supplementation.
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