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Randomized Controlled Trial
. 2019 Jan 3;380(1):23-32.
doi: 10.1056/NEJMoa1811403. Epub 2018 Nov 10.

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

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Free PMC article
Randomized Controlled Trial

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

JoAnn E Manson et al. N Engl J Med. .
Free PMC article

Abstract

Background: Higher intake of marine n-3 (also called omega-3) fatty acids has been associated with reduced risks of cardiovascular disease and cancer in several observational studies. Whether supplementation with n-3 fatty acids has such effects in general populations at usual risk for these end points is unclear.

Methods: We conducted a randomized, placebo-controlled trial, with a two-by-two factorial design, of vitamin D3 (at a dose of 2000 IU per day) and marine n-3 fatty acids (at a dose of 1 g per day) in the primary prevention of cardiovascular disease and cancer among men 50 years of age or older and women 55 years of age or older in the United States. Primary end points were major cardiovascular events (a composite of myocardial infarction, stroke, or death from cardiovascular causes) and invasive cancer of any type. Secondary end points included individual components of the composite cardiovascular end point, the composite end point plus coronary revascularization (expanded composite of cardiovascular events), site-specific cancers, and death from cancer. Safety was also assessed. This article reports the results of the comparison of n-3 fatty acids with placebo.

Results: A total of 25,871 participants, including 5106 black participants, underwent randomization. During a median follow-up of 5.3 years, a major cardiovascular event occurred in 386 participants in the n-3 group and in 419 in the placebo group (hazard ratio, 0.92; 95% confidence interval [CI], 0.80 to 1.06; P=0.24). Invasive cancer was diagnosed in 820 participants in the n-3 group and in 797 in the placebo group (hazard ratio, 1.03; 95% CI, 0.93 to 1.13; P=0.56). In the analyses of key secondary end points, the hazard ratios were as follows: for the expanded composite end point of cardiovascular events, 0.93 (95% CI, 0.82 to 1.04); for total myocardial infarction, 0.72 (95% CI, 0.59 to 0.90); for total stroke, 1.04 (95% CI, 0.83 to 1.31); for death from cardiovascular causes, 0.96 (95% CI, 0.76 to 1.21); and for death from cancer (341 deaths from cancer), 0.97 (95% CI, 0.79 to 1.20). In the analysis of death from any cause (978 deaths overall), the hazard ratio was 1.02 (95% CI, 0.90 to 1.15). No excess risks of bleeding or other serious adverse events were observed.

Conclusions: Supplementation with n-3 fatty acids did not result in a lower incidence of major cardiovascular events or cancer than placebo. (Funded by the National Institutes of Health and others; VITAL ClinicalTrials.gov number, NCT01169259 .).

Conflict of interest statement

Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest.

Figures

Figure 1.
Figure 1.
Cumulative Incidence Rates of A) Major Cardiovascular Events, B) Total Invasive Cancer, by Year of Follow-up. From Cox regression models controlling for age, sex, and vitamin D randomization group (intention-to-treat analyses).
Figure 1.
Figure 1.
Cumulative Incidence Rates of A) Major Cardiovascular Events, B) Total Invasive Cancer, by Year of Follow-up. From Cox regression models controlling for age, sex, and vitamin D randomization group (intention-to-treat analyses).
Figure 2:
Figure 2:
Hazard Ratios of Major Cardiovascular Events by Subgroups, comparing Omega-3 Fatty Acids (n-3) and Placebo Groups. From Cox regressions models controlling for age, sex, and vitamin D randomization group (intention-to-treat analyses). Analyses have not been adjusted for multiple comparisons.

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