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#Grand Rounds

Results from the VITAL Trial: Does Vitamin D Reduce Cardiovascular and Cancer Risk in the General Population?

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BACKGROUND AND PURPOSE:

  • Manson et al. (NEJM, 2018) assessed whether vitamin D reduces risk for cardiovascular disease and cancer in the general population

METHODS:

  • Randomized, double-blind placebo-controlled trial (RCT)
    • VITAL trial (VITamin D and OmegA-3 TriaL)
    • Two-by-two factorial design
      • Vitamin D3: 2000 IU per day
      • Marine n-3 fatty acids: 1 g per day
    • Participants
      • Men: ≥50 years
      • Women: ≥55 years
    • Primary outcomes
      • Major cardiovascular events
      • Invasive cancer (any)
    • Secondary outcomes
      • Site-specific cancers | Death from cancer | Additional cardiovascular events

RESULTS:

  • 25,871 participants underwent randomization
    • There was a median follow-up of 5.3 years
    • 51% women
    • Mean age 67.1 years
    • Racially diverse cohort

Vitamin D intake did not impact either primary outcome

  • Cancer
    • Vit D: 793
    • Placebo group: 824
    • Hazard ratio (HR) 0.96 (95% CI, 0.88 to 1.06; P=0.47)
  • Major cardiovascular event
    • Vit D: 396
    • Placebo: 409
    • HR: 0.97 (95% CI, 0.85 to 1.12; P=0.69)

Vitamin D intake did not impact secondary outcomes

  • Death from cancer: HR 0.83 (95% CI, 0.67 to 1.02)
  • Breast cancer: 1.02 (95% CI, 0.79 to 1.31)
  • Prostate cancer: 0.88 (95% CI, 0.72 to 1.07)
  • Colorectal cancer: 1.09 (95% CI, 0.73 to 1.62)
  • Myocardial infarction: 0.96 (95% CI, 0.78 to 1.19)
  • Stroke: 0.95 (95% CI, 0.76 to 1.20)
  • Death from cardiovascular causes: 1.11 (95% CI, 0.88 to 1.40)
  • There was no difference in death from any cause
    • HR 0.99 (95% CI, 0.87 to 1.12)
  • No excess risks of hypercalcemia or other adverse events were identified
  • Effects did not vary according to baseline serum 25-hydroxyvitamin D levels

CONCLUSION:

  • Supplementation with vitamin D does not reduce risk for cardiovascular disease or invasive cancer in an otherwise healthy population
  • Authors acknowledge that while the study was appropriately powered for the primary endpoints, longer follow-up would be necessary to truly determine risk for cancer development and would need greater ‘n’ for site specific cancers

Learn More – Primary Sources:

Vitamin D Supplements and Prevention of Cancer and Cardiovascular Disease

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

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Related ObG Topics:

Does Vitamin D Intake Decrease the Risk for Gestational Diabetes Mellitus?
Vitamin D Levels: Is There an Association with Livebirth and/or Miscarriage
Is there a Causal Link between Vitamin D and Gestational Hypertension / Preeclampsia?

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