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Ogata S, Manson JE, Kang JH, Buring JE, Lee IM, Nishimura K, Sakata Y, Danik JS, D’Agostino D, Mora S, Albert CM, Cook NR. Marine n-3 Fatty Acids and Prevention of Cardiovascular Disease: A Novel Analysis of the VITAL Trial Using Win Ratio and Hierarchical Composite Outcomes. Nutrients 2023; 15:4235. [PMID: 37836519 PMCID: PMC10574231 DOI: 10.3390/nu15194235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 09/27/2023] [Accepted: 09/28/2023] [Indexed: 10/15/2023] Open
Abstract
This study aimed to investigate whether n-3 fatty acid supplementation reduced cardiovascular disease (CVD) events in a novel analysis using hierarchical composite CVD outcomes based on win ratio in the VITamin D and OmegA-3 TriaL (VITAL). This was a secondary analysis of our VITAL randomized trial, which assessed the effects of marine n-3 fatty acids (1 g/day) and vitamin D3 on incident CVD and cancer among healthy older adults (n = 25,871). The primary analysis estimated win ratios of a composite of major CVD outcomes prioritized as fatal coronary heart disease, other fatal CVD including stroke, non-fatal myocardial infarction (MI), and non-fatal stroke, comparing n-3 fatty acids to placebo. The primary result was a nonsignificant benefit of this supplementation for the prioritized primary CVD outcome (reciprocal win ratio [95% confidence interval]: 0.90 [0.78-1.04]), similar to the 0.92 (0.80-1.06) hazard ratio in our original time-to-first event analysis without outcome prioritization. Its benefits came from reducing MI (0.71 [0.57-0.88]) but not stroke (1.01 [0.80 to 1.28]) components. For the primary CVD outcome, participants with low fish consumption at baseline benefited (0.79 [0.65-0.96]) more than those with high consumption (1.05 [0.85-1.30]). These results are consistent with, but slightly stronger than, those without outcome prioritization.
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Affiliation(s)
- Soshiro Ogata
- Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center, Suita 564-8565, Japan;
| | - JoAnn E. Manson
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA; (J.E.M.); (J.H.K.); (J.E.B.); (I.-M.L.); (D.D.); (S.M.); (C.M.A.); (N.R.C.)
| | - Jae H. Kang
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA; (J.E.M.); (J.H.K.); (J.E.B.); (I.-M.L.); (D.D.); (S.M.); (C.M.A.); (N.R.C.)
| | - Julie E. Buring
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA; (J.E.M.); (J.H.K.); (J.E.B.); (I.-M.L.); (D.D.); (S.M.); (C.M.A.); (N.R.C.)
| | - I-Min Lee
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA; (J.E.M.); (J.H.K.); (J.E.B.); (I.-M.L.); (D.D.); (S.M.); (C.M.A.); (N.R.C.)
| | - Kunihiro Nishimura
- Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center, Suita 564-8565, Japan;
| | - Yasuhiko Sakata
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita 564-8565, Japan;
| | - Jacqueline Suk Danik
- Division of Cardiovascular Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA;
| | - Denise D’Agostino
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA; (J.E.M.); (J.H.K.); (J.E.B.); (I.-M.L.); (D.D.); (S.M.); (C.M.A.); (N.R.C.)
| | - Samia Mora
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA; (J.E.M.); (J.H.K.); (J.E.B.); (I.-M.L.); (D.D.); (S.M.); (C.M.A.); (N.R.C.)
| | - Christine M. Albert
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA; (J.E.M.); (J.H.K.); (J.E.B.); (I.-M.L.); (D.D.); (S.M.); (C.M.A.); (N.R.C.)
- Department of Cardiology, Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Nancy R. Cook
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA; (J.E.M.); (J.H.K.); (J.E.B.); (I.-M.L.); (D.D.); (S.M.); (C.M.A.); (N.R.C.)
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