Effects of Vitamin D and Omega 3 Fatty Acids on Incidence Rate of Heart Failure

摘要 心力衰竭(HF)每年的支出高达数十亿美元。尽管在医疗方面取得了进步，但 心力衰竭发病后的死亡率和复发的心力衰竭失代偿率仍然很高，这突显了一个紧急的 需要确定有效的预防战略。观察性研究表明心力衰竭的死亡风险更高。 维生素D水平较低的患者和最近对试验进行的两项特别后分析，主要是在 据报道，与安慰剂相比，绝经后妇女服用维生素D组的心衰发生率降低。维生素D 据报道，该药还能改善229名心力衰竭患者的血流动力学和左心室重构。然而， 还没有随机试验检验维生素D对心力衰竭一级预防的影响或对 男性和女性反复出现的心衰代偿失代偿。二十碳五烯酸(EPA)的药效 二十二碳六烯酸(DHA)对心血管事件的影响已在低患病率的试验中得到报道 仅限使用。EPA/DHA可以降低心力衰竭的危险因素，包括心肌梗死、高血压和糖尿病。 虽然一些但不是所有的观测研究表明，EPA/DHA和 关于心力衰竭的发病率，目前还没有进行EPA/DHA对心力衰竭的大型一级预防试验。此外, 他汀类药物对EPA/DHA降压作用的影响尚未阐明。这个项目将 维生素D和EPA/DHA补充剂对心力衰竭发生率和复发的影响 美国国立卫生研究院资助的维生素D和omega-3试验(VITAL)的辅助研究中的心衰代偿 对25,874名男性和女性进行的随机对照试验，测试2,000 IU/天的胆钙化醇和1,000 IU/d的 关于心血管疾病和癌症终点的EPA/DHA。

Abstract Heart failure (HF) expenditure amounts to several billion per year. Despite advances in medical treatment of HF, mortality after HF onset and rate of recurrent HF decompensation remain high, underscoring an urgent need to identify effective prevention strategies. Observational studies showed a higher risk of death in HF patients with lower levels of vitamin D and two recent post-hoc analyses of trials conducted in mostly post- menopausal women reported a reduction in HF rates in the vitamin D group compared with placebo. Vitamin D has also been reported to improve hemodynamics and left ventricular remodeling in 229 HF patients. However, no randomized trial has examined the effects of vitamin D on primary prevention of HF or on the rate of recurrent HF decompensation in men and women. Efficacy of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) on cardiovascular events has been reported in trials with low prevalence of stain use only. EPA/DHA can reduce risk factors for HF including myocardial infarction, hypertension, and diabetes. While some but not all observational studies have suggested an inverse association between EPA/DHA and the incidence of HF, no large primary prevention trial of EPA/DHA on HF has been conducted. In addition, effect modification of the effects of EPA/DHA on HF by statin has not been elucidated. This project will investigate the effects of vitamin D and EPA/DHA supplements on the incidence rate of HF and on recurrent HF decompensation in an ancillary study of the VITamin D and OmegA-3 TriaL (VITAL), an NIH-funded randomized controlled trial of 25,874 men and women testing the efficacy of 2,000 IU/day cholecalciferol and 1 g/day EPA/DHA on cardiovascular disease and cancer endpoints.