Is vitamin A good for heart health?

Not as a pill, and beta-carotene pills slightly raise the risk. A 2022 meta-analysis of 10 randomized trials in 182,788 people found beta-carotene supplements raised the risk of dying from cardiovascular disease by 12 percent (RR 1.12, 95% CI 1.04 to 1.19). In absolute terms that is small. An earlier pooling of 8 large trials counted cardiovascular deaths in 3.4% of people on beta-carotene against 3.1% on placebo. Much of this trial evidence comes from smokers, and every one of these trials used high-dose supplements, which is a different thing from carrots or liver on a plate.

Myth. Vitamin A or beta-carotene supplements do not protect the heart. Across 15 randomized trials in 188,209 people, antioxidant vitamins, beta-carotene among them, had no effect on major cardiovascular events (RR 1.00, 95% CI 0.96 to 1.03), heart attacks or cardiac death. That review pooled three vitamins together, so it is not a test of vitamin A on its own.

What the trials found

Three syntheses point the same way for beta-carotene. Besides the 2022 meta-analysis above, the evidence review written for the US Preventive Services Task Force pooled 5 trials in 94,506 people and found higher odds of cardiovascular death with beta-carotene, with or without vitamin A (OR 1.10, 95% CI 1.02 to 1.19). The absolute risk difference between trials ran from -0.8% to 0.8%. Those trials enrolled many smokers, and that matters for who the result describes.

Unsettled. How big the harm is remains open. A second 2022 meta-analysis, of 31 trials in 216,734 adults, found beta-carotene had no preventive effect on cardiovascular or cerebrovascular death and no effect on death from any cause (RR 1.02, 95% CI 0.98 to 1.05). Its abstract gives no cause-specific numbers, so the two reviews cannot be compared line by line.

Two large trials in smokers

In the ATBC trial, 29,133 male smokers aged 50 to 69 took 20 mg of beta-carotene a day for 5 to 8 years. In the 6 years after the trial ended, those who had taken it had 14 percent more major coronary events (RR 1.14, 95% CI 1.04 to 1.24) and 16 percent more first non-fatal heart attacks (RR 1.16, 1.03 to 1.32). Fatal coronary disease was 11 percent higher with an interval that touched no effect (RR 1.11, 0.99 to 1.25). The authors found no plausible mechanism.

The CARET trial gave 18,314 smokers and asbestos workers 30 mg of beta-carotene with 25,000 IU of retinyl palmitate, a preformed vitamin A, every day. It was stopped early in January 1996. The active group had 28 percent more lung cancer, 17 percent more deaths and a higher rate of cardiovascular death than the placebo group. In a substudy of 52 participants, about 5 years of the supplements did not change total, HDL or LDL cholesterol, so cholesterol does not explain the excess heart deaths. That substudy was small, and what does explain them is still unknown.

Preformed vitamin A on its own

We found no trial that gave preformed vitamin A alone and measured heart attacks, strokes or heart deaths. The nearest evidence is about death from any cause. A Cochrane review of 67 trials in 232,550 people found vitamin A supplements raised mortality by 16 percent in the trials at low risk of bias (RR 1.16, 95% CI 1.10 to 1.24). That is all deaths, and the review cannot say how many were cardiac.

Food and blood levels, where the picture flips

Observational data from 69 prospective studies link higher dietary intake and blood levels of carotenoids, beta-carotene included, to lower coronary heart disease, stroke and cardiovascular disease. The authors read carotenoids as a marker of eating more fruit and vegetables, and they support the fruit and vegetables, not antioxidant pills. In a 30-year cohort of 29,104 men, those with higher blood retinol had 17 to 32 percent lower death rates, heart disease included, than men with the lowest levels. Blood retinol reflects vitamin A status and says nothing about supplements, and both findings are associations that cannot show cause.

Who should be careful

Not for everyone. Smokers, first. Both trials described above enrolled smokers, and in CARET the supplements raised lung cancer by 28 percent and death from lung cancer by 46 percent. The US National Institutes of Health notes that 20 mg of beta-carotene a day for 5 to 8 years raised mortality in male smokers, mainly from lung cancer and ischemic heart disease.

Pregnancy is the second group. The National Institutes of Health advises women who are or might be pregnant, and women who are breastfeeding, not to take more than 3,000 mcg RAE (10,000 IU) of vitamin A supplements a day. For adults generally the upper limit is 3,000 mcg a day of preformed vitamin A from animal foods and supplements together. It does not apply to carotenoids from plants, and it rests on liver damage, birth defects and toxic effects in children. Europe set no upper limit for beta-carotene because the data were not adequate to derive one. That is a gap in the evidence and not a statement that any amount is safe.

Bones are the third concern, and the evidence is weaker. The USPSTF review of 84 studies with 739,803 participants flagged a possible higher risk of hip fracture with vitamin A supplements, on limited evidence. Pooling prospective cohorts, a high intake of vitamin A went with higher hip fracture risk (adjusted RR 1.29, 95% CI 1.07 to 1.57) and so did high retinol intake (1.40, 1.03 to 1.91), while beta-carotene did not (0.82, 0.59 to 1.14). Those are observational and confounding was not excluded. More is not better in blood either. Among US adults with prediabetes, both low and high blood retinol went with more deaths from any cause, HR 1.40 (95% CI 1.11 to 1.76) below 50 mcg/dL and 1.26 (1.00 to 1.57) at 80 mcg/dL or above, against 50 to 60 mcg/dL.

What expert bodies say

The US Preventive Services Task Force recommends against beta-carotene supplements for preventing cardiovascular disease or cancer, a grade D recommendation, with moderate certainty that harms outweigh benefits. For other single nutrients, vitamin A among them, it found the evidence insufficient to judge benefit or harm, an I statement. Its advice is about supplements, not about carotenoids in food. We did not find a primary American Heart Association document on antioxidant supplements in the sources we trust, so we do not quote one.

How we searched

What would change this answer

• A randomized trial of preformed vitamin A alone with heart attacks, strokes or heart deaths as the outcome. We found none, and none is registered as running on ClinicalTrials.gov.
• Cause-specific numbers from the 31-trial review that found no harm. Until they are published side by side with the 10-trial review, the size of the beta-carotene harm stays uncertain.
• Trials in non-smokers. Much of the trial evidence comes from smokers, and the full-text subgroup data that would show how much of it carries over to non-smokers were not available to us.

For everything else about the nutrient, from food sources to how much you need, see the vitamin A guide linked below.

Sources

1. ev-vahd-01 · Meta-analysis or systematic review · systematic review and meta-analysis of RCTs · n = 182,788
   Results from the random-effects models indicated that β-carotene supplementation slightly increased overall cardiovascular incidence (RR: 1.04; 95% CI: 1.00, 1.08) and was constantly associated with increased cardiovascular mortality (RR: 1.12; 95% CI: 1.04, 1.19).
   
   Who: adults in randomized trials of beta-carotene supplements versus control, cardiovascular outcomes
   Effect: cardiovascular mortality RR 1.12 (95% CI 1.04 to 1.19); cardiovascular incidence RR 1.04 (1.00 to 1.08); beta-carotene given alone RR 1.06 (1.01 to 1.12)
   Certainty: harm signal concentrated in smokers; trials used high-dose supplements, not food
   Nutrients, 2022 · checked 2026-10-07 · we read the abstract
2. ev-vahd-02 · Meta-analysis or systematic review · systematic review and meta-analysis of RCTs for USPSTF · n = 94,506
   Beta carotene (with or without vitamin A) was significantly associated with an increased risk of lung cancer (OR, 1.20 [95% CI, 1.01-1.42]; 4 RCTs [n=94 830]; ARD range, -0.1% to 0.6%) and cardiovascular mortality (OR, 1.10 [95% CI, 1.02-1.19]; 5 RCTs [n=94 506] ARD range, -0.8% to 0.8%).
   
   Who: adults without cardiovascular disease or cancer and with no known vitamin or mineral deficiencies, in RCTs
   Effect: cardiovascular mortality OR 1.10 (95% CI 1.02 to 1.19); absolute risk difference -0.8% to 0.8%
   Certainty: OR is odds, not risk; the trials (ATBC, CARET) enrolled many smokers
   JAMA, 2022 · checked 2026-10-07 · we read the abstract
3. ev-vahd-03 · Meta-analysis or systematic review · systematic review of RCTs and observational studies of harms · n = 84 studies, 739,803 participants overall
   Limited evidence suggested some supplements may be associated with higher risk of serious harms (hip fracture [vitamin A], hemorrhagic stroke [vitamin E], and kidney stones [vitamin C, calcium]).
   
   Who: healthy adults taking vitamin and mineral supplements, RCTs and cohort studies of serious harms
   Effect: possible higher hip fracture risk with vitamin A; size not given in the abstract
   Certainty: limited evidence, mostly observational for this harm
   JAMA, 2022 · checked 2026-10-07 · we read the abstract
4. ev-vahd-04 · Position of an expert body · national recommendation statement based on a systematic review · n = —
   The USPSTF recommends against the use of beta carotene or vitamin E supplements for the prevention of cardiovascular disease or cancer. (D recommendation)
   
   Who: community-dwelling, nonpregnant adults
   Effect: D recommendation against beta-carotene; moderate certainty that harms outweigh benefits
   Certainty: applies to supplements, not to carotenoids in food
   JAMA, 2022 · checked 2026-10-07 · we read the abstract
5. ev-vahd-05 · Position of an expert body · national recommendation statement based on a systematic review · n = —
   The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of the use of single- or paired-nutrient supplements (other than beta carotene and vitamin E) for the prevention of cardiovascular disease or cancer. (I statement).
   
   Who: community-dwelling, nonpregnant adults
   Effect: I statement for single or paired nutrients other than beta-carotene and vitamin E
   Certainty: no recommendation for or against preformed vitamin A supplements for the heart
   JAMA, 2022 · checked 2026-10-07 · we read the abstract
6. ev-vahd-06 · Meta-analysis or systematic review · Cochrane systematic review and meta-analysis of RCTs · n = 232,550
   When the different antioxidants were assessed separately, analyses including trials with a low risk of bias and excluding selenium trials found significantly increased mortality by vitamin A (RR 1.16, 95% CI 1.10 to 1.24), beta-carotene (RR 1.07, 95% CI 1.02 to 1.11), and vitamin E (RR 1.04, 95% CI 1.01 to 1.07), but no significant detrimental effect of vitamin C (RR 1.06, 95% CI 0.94 to 1.20).
   
   Who: healthy people and patients with various diseases in primary or secondary prevention trials of antioxidant supplements
   Effect: all-cause mortality, low-bias trials: vitamin A RR 1.16 (95% CI 1.10 to 1.24); beta-carotene RR 1.07 (1.02 to 1.11)
   Certainty: all-cause, not cardiac, mortality; estimate restricted to low-bias trials excluding selenium
   Cochrane Database Syst Rev, 2008 · checked 2026-10-07 · we read the abstract
7. ev-vahd-07 · Meta-analysis or systematic review · meta-analysis of RCTs · n = 138,113
   Beta carotene led to a small but significant increase in all-cause mortality (7.4 vs 7.0%, 1.07 [1.02-1.11] p=0.003) and with a slight increase in cardiovascular death (3.4 vs 3.1%, 1.1 [1.03-1.17] p=0.003).
   
   Who: patients in 8 randomized trials of beta-carotene 15 to 50 mg, each with 1000 or more patients, follow-up 1.4 to 12 years
   Effect: cardiovascular death 3.4% vs 3.1%, OR 1.1 (95% CI 1.03 to 1.17); all-cause mortality OR 1.07 (1.02 to 1.11)
   Certainty: OR is odds, not risk; older synthesis consistent with 2022 reviews
   Lancet, 2003 · checked 2026-10-07 · we read the abstract
8. ev-vahd-08 · Meta-analysis or systematic review · systematic review and meta-analysis of RCTs · n = 216,734
   In a random-effects meta-analysis of all 31 trials, beta-carotene supplements were found to have no preventive effect on mortality (risk ratio 1.02, 95% confidence interval 0.98-1.05, I 2 = 42%). Further, the analysis showed no preventive effect on cancer, cardiovascular, cerebrovascular, and other mortality causes.
   
   Who: adults with any health condition in RCTs of beta-carotene at any dose versus placebo or no intervention
   Effect: all-cause mortality RR 1.02 (95% CI 0.98 to 1.05); no preventive effect on cardiovascular or cerebrovascular mortality
   Certainty: disagrees with 35334942 on cardiovascular harm: no harm reported here, but also no benefit; cause-specific estimates not given in the abstract
   Front Med (Lausanne), 2022 · checked 2026-10-07 · we read the abstract
9. ev-vahd-09 · Meta-analysis or systematic review · meta-analysis of RCTs · n = 188,209
   Overall, antioxidant vitamin supplementation as compared to placebo had no effect on major cardiovascular events (RR, 1.00; 95%CI, 0.96-1.03), myocardial infarction (RR, 0.98; 95%CI, 0.92-1.04), stroke (RR, 0.99; 95%CI, 0.93-1.05), total death (RR, 1.03; 95%CI, 0.98-1.07), cardiac death (RR, 1.02; 95%CI, 0.97-1.07), revascularization (RR, 1.00; 95%CI, 0.95-1.05), total CHD (RR, 0.96; 95%CI, 0.87-1.05), angina (RR, 0.98; 95%CI, 0.90-1.07), and congestive heart failure (RR, 1.07; 95%CI, 0.96 to 1.19).
   
   Who: participants in RCTs of vitamin E, beta-carotene or vitamin C versus placebo
   Effect: major cardiovascular events RR 1.00 (95% CI 0.96 to 1.03); myocardial infarction RR 0.98 (0.92 to 1.04); cardiac death RR 1.02 (0.97 to 1.07)
   Certainty: pools three antioxidants together; not specific to vitamin A
   PLoS One, 2013 · checked 2026-10-07 · we read the abstract
10. ev-vahd-10 · Randomized controlled trial(s) · randomized double-blind placebo-controlled trial, post-intervention follow-up · n = 18,314
    CARET was stopped ahead of schedule in January 1996 because participants who were randomly assigned to receive the active intervention were found to have a 28% increase in incidence of lung cancer, a 17% increase in incidence of death and a higher rate of cardiovascular disease mortality compared with participants in the placebo group.
    
    Who: 18,314 participants at high risk for lung cancer because of smoking or asbestos exposure; 30 mg beta-carotene and 25,000 IU retinyl palmitate daily
    Effect: post-intervention cardiovascular mortality RR females 1.44 vs males 0.93 (P = .03); excess cardiovascular risk fell to 1.0 after stopping
    Certainty: trial stopped early for harm; sex differences come from planned subgroup analyses
    J Natl Cancer Inst, 2004 · checked 2026-10-07 · we read the abstract
11. ev-vahd-11 · Randomized controlled trial(s) · randomized double-blind placebo-controlled trial, post-trial follow-up · n = 29,133
    Post-trial risk for MCE (n=2059) was 0.95 (95% confidence interval 0.87-1.04) among alpha-tocopherol recipients compared with non-recipients, and 1.14 (1.04-1.24) among beta-carotene recipients compared with non-recipients. The risk for non-fatal MI (n=993) was 0.96 (0.85-1.09) and 1.16 (1.03-1.32), and for fatal CHD (n=1066) 0.94 (0.83-1.06) and 1.11 (0.99-1.25), respectively.
    
    Who: 29,133 male smokers aged 50-69 years; beta-carotene 20 mg daily for 5-8 years, 6-year post-trial follow-up
    Effect: major coronary event RR 1.14 (95% CI 1.04 to 1.24); non-fatal MI RR 1.16 (1.03 to 1.32); fatal CHD RR 1.11 (0.99 to 1.25)
    Certainty: smokers only; authors found no plausible mechanism
    Eur Heart J, 2004 · checked 2026-10-07 · we read the abstract
12. ev-vahd-12 · Randomized controlled trial(s) · lipid substudy within an RCT · n = 52
    These results argue against a major contribution of treatment-induced changes in serum lipid and lipoprotein levels to the increased cardiovascular mortality in the active treatment group.
    
    Who: subgroup of 52 CARET participants (23 placebo, 29 active), 30 mg beta-carotene and 25,000 IU retinyl palmitate
    Effect: small nonsignificant rise in triglycerides; no change in total, HDL or LDL cholesterol
    Certainty: small convenience sample; mechanism of the CARET cardiovascular signal remains unexplained
    Atherosclerosis, 1999 · checked 2026-10-07 · we read the abstract
13. ev-vahd-13 · Observational data · systematic review and dose-response meta-analysis of prospective studies · n = 69 prospective studies
    Dietary intake and/or blood concentrations of carotenoids (total, β-carotene, α-carotene, β-cryptoxanthin, lycopene) and α-tocopherol, but not dietary vitamin E, were similarly inversely associated with coronary heart disease, stroke, cardiovascular disease, cancer, and/or all-cause mortality.
    
    Who: adults in prospective cohort studies of dietary intake or blood concentrations of antioxidants
    Effect: inverse associations with coronary heart disease, stroke and cardiovascular disease; read by the authors as markers of fruit and vegetable intake
    Certainty: association only; authors support more fruit and vegetables, not antioxidant supplements
    Am J Clin Nutr, 2018 · checked 2026-10-07 · we read the abstract
14. ev-vahd-14 · Observational data · prospective cohort study · n = 29,104
    Participants with higher serum retinol experienced significantly lower overall, CVD, heart disease, and respiratory disease mortality compared to men with the lowest retinol concentrations, reflecting 17-32% lower mortality risk (Ptrend < 0.0001).
    
    Who: 29,104 men followed for 30 years, serum retinol measured at baseline
    Effect: 17-32% lower overall, CVD, heart disease and respiratory mortality with higher serum retinol (P trend < 0.0001)
    Certainty: serum retinol reflects status, not supplement intake; association only
    Nat Commun, 2021 · checked 2026-10-07 · we read the abstract
15. ev-vahd-15 · Observational data · cohort study · n = 4,236
    Among participants with prediabetes, compared to serum retinol levels of 50-60 μg/dL, the hazard ratio (HR) (95% confidence interval [CI]) of mortality was 1.40 (95% CI 1.11 to 1.76) and 1.26 (95% CI 1.00 to 1.57) for serum retinol <50 or ≥80 μg/dL, respectively.
    
    Who: 2582 participants with prediabetes and 1654 with diabetes aged 40 or older, NHANES 2001-2006
    Effect: prediabetes: mortality HR 1.40 (95% CI 1.11 to 1.76) for retinol <50 and 1.26 (1.00 to 1.57) for >=80 vs 50-60 microgram/dL
    Certainty: all-cause, not cardiac, mortality; supports caution about more being better
    PLoS One, 2024 · checked 2026-10-07 · we read the abstract
16. ev-vahd-16 · Position of an expert body · government fact sheet · n = —
    However, the ATBC trial found that supplementation with a large amount of beta-carotene (20 mg/day), with or without 50 mg/day vitamin E, for 5–8 years increased the risk of lung cancer and mortality (mainly from lung cancer and ischemic heart disease) in male smokers [70].
    
    Who: male smokers in the ATBC trial
    Effect: higher lung cancer risk and mortality, mainly lung cancer and ischemic heart disease
    Certainty: body summary of the ATBC trial; backed by T1 cards 11 and 01
    NIH Office of Dietary Supplements, Vitamin A and Carotenoids Fact Sheet for Health Professionals · checked 2026-10-07 · we read the section
17. ev-vahd-17 · Position of an expert body · government fact sheet · n = —
    The FNB based these ULs on the amounts associated with an increased risk of liver abnormalities in men and women, teratogenic effects, and several toxic effects in infants and children.
    
    Who: all age groups; adult UL 3,000 mcg RAE of preformed vitamin A
    Effect: UL basis: liver abnormalities, teratogenic effects, toxic effects in infants and children
    Certainty: UL covers preformed vitamin A, not beta-carotene
    NIH Office of Dietary Supplements, Vitamin A and Carotenoids Fact Sheet for Health Professionals · checked 2026-10-07 · we read the section
18. ev-vahd-18 · Position of an expert body · government fact sheet · n = —
    Experts advise women who are or might be pregnant and those who are lactating not to take high doses (more than 3,000 mcg RAE [10,000 IU] daily) of vitamin A supplements [1].
    
    Who: women who are or might be pregnant and lactating women
    Effect: avoid supplemental vitamin A above 3,000 mcg RAE (10,000 IU) a day because of birth defect risk
    Certainty: limit applies to preformed vitamin A
    NIH Office of Dietary Supplements, Vitamin A and Carotenoids Fact Sheet for Health Professionals · checked 2026-10-07 · we read the section
19. vita-03 · Position of an expert body
    3,000 mcg for adults age 19 and older, applying only to products from animal sources and supplements
    
    Who: general adults
    Effect: upper limit
    NIH Office of Dietary Supplements, VitaminA - Health Professional Fact Sheet · checked 2026-09-16
20. vita-08 · Randomized controlled trial(s)
    The trial was ended prematurely after a mean of 4 years, partly because the supplements were unexpectedly found to have increased lung cancer risk by 28% and death from lung cancer by 46%; the supplements also increased the risk of all-cause mortality by 17%
    
    Who: smokers and asbestos-exposed adults in the CARET trial
    Effect: 28% more lung cancer, 46% more lung cancer deaths, 17% higher all-cause mortality
    NIH Office of Dietary Supplements, Vitamin A - Health Professional Fact Sheet · checked 2026-09-16
21. vita-t7 · Observational data · meta-analysis of prospective cohort studies of intake and of blood retinol · n = 283,930 in the intake cohorts, 8,725 in the blood retinol cohorts
    Eight vitamin A (or retinol or beta-carotene) intake studies (283,930 participants) and four blood retinol level prospective studies (8725 participants) were included...High intake of vitamin A and retinol were shown to increase risk of hip fracture (adj.RR [95% CI] = 1.29 [1.07, 1.57] and 1.40 [1.03, 1.91], respectively), whereas beta-carotene intake was not found to increase the risk of hip fracture (adj.RR [95% CI] = 0.82 [0.59, 1.14]).
    
    Who: adults in 8 cohorts of vitamin A, retinol or beta-carotene intake and 4 cohorts with measured blood retinol
    Effect: hip fracture adjusted relative risk 1.29 (95% CI 1.07 to 1.57) for high vitamin A intake and 1.40 (95% CI 1.03 to 1.91) for high retinol intake; beta-carotene 0.82 (95% CI 0.59 to 1.14)
    Certainty: observational only, dose-response U-shaped so both low and high retinol carried risk, confounding not excluded
    Wu et al., Journal of Bone and Mineral Research, 2014 · checked 2026-09-17 · we read the abstract
22. vita-e2-08 · Position of an expert body
    β-Carotene(c) No adequate data to derive a UL
    
    Who: European Union population, with a separate warning aimed at smokers
    Effect: upper level for preformed vitamin A retained at 3,000 mcg RE a day for adults, graded down to 600 mcg for the youngest children; no upper level derivable for beta-carotene, with smokers advised to avoid supplements containing it
    Certainty: no upper level for beta-carotene means no number could be calculated, not that any amount is safe. Read against our own cards vita-r6-02 and vita-t3, which record that beta-carotene supplements raised lung cancer in smokers, the absence of a limit is a gap rather than a reassurance
    Overview on Tolerable Upper Intake Levels as derived by the EFSA NDA Panel, European Food Safety Authority, 2024 · checked 2026-09-18 · we read the full text