Whether marine omega-3 fatty acid (n-3 FA) or vitamin D supplementation can prevent cardiovascular disease (CVD) in general populations at usual risk for this outcome is unknown. A major goal of VITAL (Vitamin D and Omega-3 Trial) was to fill this knowledge gap. In this article, we review the results of VITAL, discuss relevant mechanistic studies regarding n-3 FAs, vitamin D, and vascular disease, and summarize recent meta-analyses of the randomized trial evidence on these agents. VITAL was a nationwide, randomized, placebo-controlled, 2×2 factorial trial of marine n-3 FAs (1 g/d) and vitamin D3 (2000 IU/d) in the primary prevention of CVD and cancer among 25 871 US men aged ≥50 and women aged ≥55 years, including 5106 blacks. Median treatment duration was 5.3 years. Supplemental n-3 FAs did not significantly reduce the primary cardiovascular end point of major CVD events (composite of myocardial infarction, stroke, and CVD mortality; hazard ratio [HR], 0.92 [95% CI, 0.80-1.06]) but 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]) but not stroke or other cardiovascular end points. For major CVD events, a treatment benefit was seen in those with dietary fish intake below the cohort median of 1.5 servings/wk (HR, 0.81 [95% CI, 0.67-0.98]) but not in those above (P interaction=0.045). For myocardial infarction, the greatest risk reductions were in blacks (HR, 0.23 [95% CI, 0.11-0.47]; P interaction by race, 0.001). Vitamin D supplementation did not reduce major CVD events (HR, 0.97 [95% CI, 0.85-1.12]) or other cardiovascular end points. Updated meta-analyses that include VITAL and other recent trials document coronary risk reduction from supplemental marine n-3 FAs but no clear CVD risk reduction from supplemental vitamin D. Additional research is needed to determine which individuals may be most likely to derive net benefit from supplementation. Clinical Trial Registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01169259.

中文翻译：

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维生素D，海洋n-3脂肪酸和心血管疾病的一级预防当前证据。

尚不知道海洋中的omega-3脂肪酸（n-3 FA）或维生素D的补充是否可以预防通常具有此结果风险的普通人群中的心血管疾病（CVD）。VITAL（维生素D和Omega-3试验）的主要目标是填补这一知识空白。在本文中，我们回顾了VITAL的结果，讨论了有关n-3 FA，维生素D和血管疾病的相关机理研究，并总结了有关这些药物的随机试验证据的最新荟萃分析。VITAL是一项全国性的，随机，安慰剂对照的2×2因子分解试验，涉及海洋n-3 FAs（1 g / d）和维生素D3（2000 IU / d）在CVD和癌症的一级预防中的作用，涉及25871名美国男性年龄≥50岁且年龄≥55岁的女性，包括5106名黑人。中位治疗时间为5。3年。补充n-3 FAs并不能显着降低主要CVD事件的主要心血管终点（心肌梗塞，中风和CVD死亡率的综合；危险比[HR]，0.92 [95％CI，0.80-1.06]），但相关总心肌梗塞（HR，0.72 [95％CI，0.59-0.90]），经皮冠状动脉介入治疗（HR，0.78 [95％CI，0.63-0.95]）和致命性心肌梗塞（HR，0.50 [95]显着降低％CI，0.26-0.97]），但未中风或其他心血管终点。对于主要的CVD事件，在饮食鱼类摄入量低于队列中位数1.5份/周的患者（HR，0.81 [95％CI，0.67-0.98]）中发现了治疗益处，但在上述人群中则没有（P相互作用= 0.045） 。对于心肌梗塞，降低风险最大的是黑人（HR，0.23 [95％CI，0.11-0.47]；种族间P相互作用，0.001）。补充维生素D并不能减少主要的CVD事件（HR，0.97 [95％CI，0.85-1.12]）或其他心血管终点。包括VITAL和其他近期试验在内的最新荟萃分析表明，补充海洋n-3 FA可以降低冠心病风险，但是补充维生素D不能明显降低CVD风险。还需要进一步的研究以确定哪些个体最有可能从中获得净收益补充。临床试验注册：URL：http://www.clinicaltrials.gov。唯一标识符：NCT01169259。需要进行额外的研究以确定哪些人最有可能从补充中获得净收益。临床试验注册：URL：http://www.clinicaltrials.gov。唯一标识符：NCT01169259。需要进行额外的研究以确定哪些人最有可能从补充中获得净收益。临床试验注册：URL：http://www.clinicaltrials.gov。唯一标识符：NCT01169259。