Omega-3 fatty acids may have role in CVD prevention, but vitamin D supplements do not
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Trials of omega-3 fatty acids have indicated they may have a role in CVD prevention, but the same cannot be said for vitamin D supplements, according to a speaker.
In the VITAL trial, marine omega-3 fatty acids (eicosapentaenoic acid plus docosahexaenoic acid in a 1.2:1 ratio, 1 g per day) did not significantly reduce major adverse CV events, mainly because they had no impact on stroke, but they did reduce risk for MI compared with placebo containing olive oil, JoAnn E. Manson, MD, DrPH, FAHA, chief of the division of preventive medicine at Brigham and Women’s Hospital and professor of medicine and the Michael and Lee Bell Professor of Women’s Health at Harvard Medical School, said during the Nanette Wenger, MD, Award Lecture at the virtual American Society for Preventive Cardiology Congress on CVD Prevention.
In the REDUCE-IT trial, the pharmaceutical-grade omega-3 fatty acid icosapent ethyl (Vascepa, Amarin) at a dose of 4 g per day reduced risk for major adverse CV events as well as CV death, MI and stroke individually compared with mineral oil placebo, Manson said, noting that meta-analyses have shown that omega-3 fatty acids appear to reduce risk for CHD and CVD in higher doses, and possibly at greater concentrations of EPA and at lower/no concentrations of DHA.
However, she said, VITAL and other trials have found no evidence for CVD prevention from vitamin D supplementation, though there may be evidence for cancer mortality reduction.
Among the implications for primary CVD prevention is that fish consumption of at least two servings per week should be encouraged, Manson said.
“Even if marine omega-3s don’t have cardiovascular benefit, the fish will replace less healthful foods such as red meat or processed foods,” she said. “For those who have low fish consumption, either because they really dislike fish or just do not eat fish, if they are not allergic, they may want to talk with their health care provider about taking a marine omega-3 supplement. Those who are vegetarian or vegan may want to talk with their health care provider about an algae-based supplement.”
A replication trial of omega-3 fatty acids in high-risk primary prevention patients, particularly Black individuals, should be conducted, she said.
For vitamin D supplementation, “the results would suggest no clear change from the National Academy of Medicine 2011 guidelines stating there is no clear evidence to recommend vitamin D supplementation for reducing cardiovascular disease,” she said. “We need additional research on cancer, particularly cancer death benefits. There is a lot of latitude for clinicians to give higher doses of vitamin D (above the recommended daily allowance of 600 to 800s IU per day) for patients with osteoporosis, other bone health disorders, malabsorption disorders or inflammatory bowel disease/celiac disease or other indications. We do recommend avoiding mega-doses of 10,000 IUs per day and higher because their safety has not been established with long-term use.”
More extended-use and ancillary results from VITAL are expected to be published in the next 6 months, and the VIVID randomized trial of vitamin D 3,200 IU per day to prevent severe symptoms in patients with COVID-19 is underway, Manson said.
References:
- Bhatt DL, et al. N Engl J Med. 2018;doi:10.1056/NEJMoa1812792.
- Manson JE, et al. N Engl J Med. 2018;doi:10.1056/NEJMoa1809944.
- Manson JE, et al. N Engl J Med. 2018;doi:10.1056/NEJMoa1811403.
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Manson JE. Nanette Wenger, MD, Award and Lectureship. Presented at: American Society for Preventive Cardiology Congress on CVD Prevention; July 23-25, 2021 (virtual meeting).
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