Marine n−3 Fatty Acids and Prevention of Cardiovascular Disease and Cancer

Abstract

Background Whether omega-3 fatty acid supplementation reduces risk of cardiovascular disease or cancer remains unclear. Methods The VITamin D and OmegA-3Trial (VITAL) was a randomized, placebo-controlled, 2X2 factorial trial of vitamin D3 (2000IU/day) and marine omega-3 fatty acids (1 g/day) in the primary prevention of cardiovascular disease and cancer among 25,871 U.S. men aged ≥50 and women aged >55, including 5,106 African Americans. Primary endpoints were major cardiovascular events (myocardial infarction, stroke, and cardiovascular mortality) and total invasive cancer. Secondary outcomes included individual components of the cardiovascular composite, the composite plus coronary revascularization, site-specific cancers, and cancer mortality. This paper reports the results of omega-3 and placebo. Results During a median 5.3 years, rates of the primary outcomes did not differ between the omega-3 and placebo groups -- 805 participants had a major cardiovascular event, hazard ratio [HR]= 0.92; 95% confidence interval [CI], 0.80–1.06, p= 0.24. Invasive cancer was diagnosed in 1,617 participants, HR 1.03 (0.93-1.13, p=0.56). In the analysis of key secondary endpoints, hazard ratios and 95% CIs comparing omega-3 to placebo were: expanded cardiovascular events, HR 0.93 (0.82-1.04); total myocardial infarction HR 0.72 (0.59-0.90); total stroke, HR 1.04 (0.83-1.31); cardiovascular mortality HR 0.96 (0.76-1.21); and cancer deaths (n=341, HR 0.97 (0.79-1.20). For all-cause mortality (n=978), the HR was 1.02 (0.90-1.15). No excess risks of bleeding or other serious adverse events were observed. Conclusions Omega-3 fatty acid supplementation did not reduce major cardiovascular events or cancer incidence.

A blood‐based nutritional risk index explains cognitive enhancement and decline in the multidomain Alzheimer prevention trial

“…This notion has emerged in trials of homocysteine (HCy)‐lowering B vitamins to slow cognitive decline and reduce total brain atrophy in people with hyperhomocysteinemia and higher baseline n‐3 polyunsaturated fatty acid (PUFA) in circulation [7,9]. These findings are consistent with several other nutritional interventions in older adults that targeted those with suboptimum nutritional status in primary [6] or secondary analyses [10] or determined a posteriori that baseline nutritional status dictated efficacy [2,3,8].…”

Cardiovascular Risk Categories in Patients With Nonalcoholic Fatty Liver Disease and the Role of Low‐Density Lipoprotein Cholesterol

“…Beyond the CVD risk, statins have been attributed to a favorable effect on hepatocellular carcinoma incidence in a case‐control study, and thus their use can be beneficial from both a liver and CVD perspective. Additional measures to improve the CV risk could be the addition of omega n‐3 fatty acid supplements that were recently shown to decrease CV risk …”

Rounding the corner on residual risk: Implications of REDUCE‐IT for omega‐3 polyunsaturated fatty acids treatment in secondary prevention of atherosclerotic cardiovascular disease

“…In 2018, the results of two major trials (ASCEND and VITAL) of omega‐3 PUFA (1 g per day) for primary prevention of CV disease were reported . Neither trial reported a significant reduction in the risk of a composite cardiovascular endpoint in the omega‐3 PUFA group compared to the placebo group, although the VITAL trial reported a significantly lower rate of myocardial infarction in the omega‐3 PUFA arm.…”