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Randomized Controlled Trial
. 2022 Apr;10(4):227-234.
doi: 10.1016/j.jchf.2021.12.006. Epub 2022 Mar 9.

Diabetes Mellitus, Race, and Effects of Omega-3 Fatty Acids on Incidence of Heart Failure Hospitalization

Luc Djoussé  1 , Nancy R Cook  2 , Eunjung Kim  3 , Joseph Walter  3 , Omar T Al-Ramady  3 , Heike Luttmann-Gibson  4 , Christine M Albert  5 , Samia Mora  2 , Julie E Buring  2 , J Michael Gaziano  6 , JoAnn E Manson  2
Affiliations
Randomized Controlled Trial

Diabetes Mellitus, Race, and Effects of Omega-3 Fatty Acids on Incidence of Heart Failure Hospitalization

Luc Djoussé et al. JACC Heart Fail. 2022 Apr.

Abstract

Objectives: The primary aim was to evaluate whether prevalent type 2 diabetes (T2D) modifies the effects of omega-3 supplementation on heart failure (HF) hospitalization. The secondary aim was to examine if race modifies the effects of omega-3 supplements on HF risk.

Background: It is unclear whether race and T2D modify the effects of omega-3 supplementation on the incidence of HF.

Methods: In this ancillary study of the parent VITAL (Vitamin D and Omega-3 Trial)-a completed randomized trial testing the efficacy of vitamin D and omega-3 fatty acids on cardiovascular diseases and cancer, we assessed the role of T2D and race on the effects of omega-3 supplements on the incidence of HF hospitalization (adjudicated by a review of medical records and supplemented with a query of Centers for Medicare and Medicaid Services data).

Results: When omega-3 supplements were compared with placebo, the HR for first HF hospitalization was 0.69 (95% CI: 0.50-0.95) in participants with prevalent T2D and 1.09 (95% CI: 0.88-1.34) in those without T2D (P for interaction = 0.019). Furthermore, prevalent T2D modified the effects of omega-3 fatty acids on the incidence of recurrent HF hospitalization (HR: 0.53; 95% CI: 0.41-0.69 in participants with prevalent T2D vs HR: 1.07; 95% CI: 0.89-1.28 in those without T2D; P interaction <0.0001). In our secondary analysis, omega-3 supplementation reduced recurrent HF hospitalization only in Black participants (P interaction race × omega-3 = 0.0497).

Conclusions: Our data show beneficial effects of omega-3 fatty acid supplements on incidence of HF hospitalization in participants with T2D but not in those without T2D, and such benefit appeared to be stronger in Black participants with T2D. (Intervention With Vitamin D and Omega-3 Supplements and Incident Heart Failure; NCT02271230; Vitamin D and Omega-3 Trial [VITAL]; NCT01169259 [parent study]).

Keywords: heart failure; marine omega-3 fatty acids; race; type 2 diabetes.

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Conflict of interest statement

Funding Support and Author Disclosures The current ancillary study was supported by grant R01HL131687 (Dr Djoussé) from the National Heart, Lung, and Blood Institute, Bethesda, Maryland. The parent VITAL was supported by grants U01 CA138962 and R01 CA138962 from the National Institutes of Health and the Office of Dietary Supplements. Dr Mora was supported by K24HL136852, R01HL134811, and R01DK112940. Pharmavite LLC of Northridge, California (vitamin D) and Pronova BioPharma of Norway and BASF (Omacor fish oil) donated the study agents, matching placebos, and packaging in the form of calendar packs. Quest Diagnostics (San Juan Capistrano, California) measured serum 25-hydroxyvitamin D and plasma phospholipid omega-3 fatty acids at no cost to the study. Dr Djoussé has received investigator-initiated grants from Amarin Inc and Merck; and serves as co-principal investigator on a project funded by Novartis. Dr Mora has served as a consultant to Quest Diagnostics and Pfizer. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

Central Illustration:
Central Illustration:. Cumulative Incidence rate of heart failure
Cumulative incidence rates of first heart failure hospitalization (combined confirmed cases and cases identified via CMS), according to year of follow-up and randomization to n-3 fatty acids (blue) versus placebo (red) in people with T2D (panel A) or without T2D (panel B)
See this image and copyright information in PMC

Comment in

References

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