Vitamin D, Marine n-3 Fatty Acids, and Primary Prevention of Cardiovascular Disease Current Evidence.
Level 2 - randomized trial
Individual randomized controlled trial report/review
PubMed 31895658 · doi:10.1161/CIRCRESAHA.119.314541
What was done
This paper reviews results from the VITAL trial and related meta-analyses assessing marine omega-3 fatty acids and vitamin D3 for primary prevention of cardiovascular disease (CVD). VITAL was a nationwide, randomized, placebo-controlled, 2×2 factorial trial evaluating marine omega-3 fatty acids (1 g/day) and vitamin D3 (2000 IU/day) in 25,871 US men (aged ≥50) and women (aged ≥55), including 5,106 Black participants, over a median treatment duration of 5.3 years.
What was found
Omega-3 fatty acids did not significantly reduce the primary composite endpoint of major CVD events (HR 0.92, 95% CI 0.80-1.06). However, omega-3s were associated with significant reductions in total myocardial infarction (HR 0.72, 95% CI 0.59-0.90), percutaneous coronary intervention (HR 0.78, 95% CI 0.63-0.95), and fatal myocardial infarction (HR 0.50, 95% CI 0.26-0.97), with no effect on stroke. Benefit for major CVD events was observed in participants consuming <1.5 fish servings/week (HR 0.81, 95% CI 0.67-0.98; P interaction=0.045), and the greatest myocardial infarction reduction occurred in Black participants (HR 0.23, 95% CI 0.11-0.47; P interaction=0.001). Vitamin D3 supplementation did not reduce major CVD events (HR 0.97, 95% CI 0.85-1.12) or other cardiovascular endpoints.
Why it matters
Neither agent significantly lowered overall major CVD events in a primary prevention population, though marine omega-3 fatty acids demonstrated significant reductions in coronary endpoints, especially among individuals with low dietary fish intake.
Limits
The primary composite cardiovascular endpoints for both interventions were null. Secondary coronary endpoints and subgroup interactions (race, fish intake) are exploratory and require replication. Only a single fixed dose of each supplement was evaluated.
Cited by
- supports In the VITAL trial, omega-3 supplementation resulted in a major reduction in the risk of heart attack, and participants with low baseline fish intake experienced a significant reduction in the primary composite cardiovascular endpoint.