Marine omega-3s and vitamin D have been implicated in upstream biologic processes involved in electrical and structural remodelling of the atria. In observational studies, patients with low levels of these nutrients tend to have an elevated risk of AF. Dietary supplements have appeal in primary prevention given the relative ease of administration to broad populations. The VITAL Rhythm Study (NCT02178410) is an ancillary trial of the VITAL trial. The VITAL trial tested daily supplementation with 2000 IU of vitamin D3 and/or 840 mg of omega-3 fatty acids (Omacor 1g/d; 465 mg eicosapentaenoic acid [EPA] + 375 mg of docosahexaenoic acid [DHA]) for the prevention of cardiovascular disease. From this trial, 25,119 participants without a history of AF were enrolled in the VITAL Rhythm Study. Mean age was 67 years, 51% were women, 21% Black. The primary endpoint was incident AF. At the time of presentation, the VITAL Rhythm Study had 92% power to detect a 20% reduction or increase in the observed HR for incident AF.
Over 5.3 years of treatment, 3.6% (n=900) of the study population had a confirmed AF event. In 58.4% (n=526) it was paroxysmal, in 38.4% (n=346) persistent. Symptoms were present at diagnosis in 61.9% of cases (n=557). An intention-to-treat analysis revealed no benefit from EPA/DHA on the risk of new-onset AF. In fact, as first author Prof. Christine Albert (Cedars-Sinai Medical Center, USA) pointed out, the risk was slightly higher than placebo: HR 1.09 (95% CI 0.96â1.24; P=0.19). The result was very similar for vitamin D3: HR 1.09 (95% CI 0.96â1.25; P=0.19). Prof. Albert said that these findings do not support the use of EPA/DHA or vitamin D3 for the primary prevention of incident AF, but neither do they show an increased risk for patients who use these supplements for other indications. A sensitivity analysis of on-treatment incidence alone showed a trend for more AF events in the EPA/DHA group: HR 1.13 (95% CI 0.98â1.30; P=0.09). These findings add to the negative primary results of the VITAL trial [2]. Prof. Albert added that future primary prevention AF trials are needed to test other prophylactic strategies.
- Albert CM, et al. The Vital Rhythm Trial: Omega-3 Fatty Acid and Vitamin D Supplementation in the Primary Prevention of Atrial Fibrillation. LBS.01, AHA Scientific Sessions 2020, 13â17 Nov.
- Manson JE, et al. N Engl J Med. 2019;380(1):33â44.
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Table of Contents: AHA 2020
Featured articles
COVID-19 and Influenza
Fewer CV complications than expected in AHA COVID-19 Registry
Worse COVID-19 outcomes in younger obese patients
Effects of CVD in hospitalised COVID-19 patients
Unfavourable outcomes for COVID-19 patients with AF and atrial flutter
High-dose influenza vaccine in patients with CVD
Atrial Fibrillation
Vitamin D or omega 3 fatty acids do not prevent AF
Active screening for AF improves clinical outcomes
AF screening in older adults at primary care visits
CVD Risk Reduction
Clever trial design gets patients back on statins: the SAMSON trial
Polypill plus aspirin reduces cardiovascular events
Lowering LDL cholesterol in older patients is beneficial
No CV benefit from omega 3 in high-risk patients
Safety and efficacy of inclisiran for hypercholesterolemia
Remote risk management programme effective and efficient
Healthy lifestyle lowers mortality irrespective of medication burden
Heart Failure
Omecamtiv mecarbil improves outcomes in HFrEF-patients
IV iron reduces HF hospitalisation
Dapagliflozin reduces renal risk independent of CV disease status
âStrongly consider an SGLT2-inhibitor in most T2DM patientsâ
Additional HFrEF education and patient-engagement tools
Acute Coronary Syndrome
No benefit from omega-3 fatty acids after recent MI
PIONEER III trial: Drug-eluting stents comparable
Coronary and Valve Disease
Extra imaging reveals cause of MINOCA in women
Ticagrelor not superior to clopidogrel after elective PCI
Stroke
Ticagrelor/aspirin reduces stroke risk in patients with ipsilateral cervicocranial plaque
AF monitoring following cardiovascular surgery
Miscellaneous
PAD: Rivaroxaban reduces VTE risk after revascularisation
Sotatercept: potential new treatment option for PAH
Finerenone lowers CV events in diabetic CKD patients
Mavacamten effective in obstructive hypertrophic cardiomyopathy
Children exposed to tobacco smoke have worse heart function as adults
Transgender people have unaddressed heart disease risks
Intensive blood pressure lowering benefits older adults
Longer chest compression pause worsens outcomes after paediatric IHCA
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