Omega-3 fatty acids reduce HF hospitalization in T2DM patients
Diabetes Mellitus, Race, and Effects of Omega-3 Fatty Acids on Incidence of Heart Failure HospitalizationLiterature - Djoussé L, Cook NR, Kim E, et al. - JACC Heart Fail. 2022 Apr;10(4):227-234
Introduction and methods
The VITAL-HF study, an ancillary study of the VITAL trial, – which included > 5000 black participants – demonstrated that marine omega-3 fatty acids reduced the number of recurrent HF hospitalizations . Nevertheless data on the effects of omega-3 fatty acids on the incidence of HF in general terms and in patients with type 2 diabetes mellitus (T2DM) are limited and inconsistent. Also, the role of race/ethnicity in assessing the interaction of T2DM with omega-3 supplementation on first and recurrent HF hospitalization has not been evaluated before.
Aim of the study
Primary objective of the current analysis of the VITAL-HF study was to assess the effects of omega-3 supplementation on the incidence of first and recurrent HF hospitalization in patients with T2DM and in those without T2DM. As a secondary objective, researchers aimed to assess whether race modified the effect of omega-3 fatty acids on HF hospitalization.
The VITAL trial was a randomized, placebo-controlled trial investigating the effect of vitamin D and marine omega-3 fatty acids (a mixture of 460 mg EPA and 380 mg DHA) on the prevention of CVD and cancer. Median follow-up was 5.3 years (range: 0-6.1 years). In the VITAL-HF study, 25,835 participants without HF at baseline were included. The overall prevalence of T2DM was 14%. 71.3% of participants were white (non-Hispanic) and 20.2% were black.
Primary outcome in the current analysis of the VITAL-HF study was first HF hospitalization. Secondary outcome was recurrent HF hospitalization.
- First HF hospitalization occurred in 3.6% of people with T2DM who received omega-3 fatty acids and 5.2% of people with T2D who received placebo (HR 0.69, 95%CI:0.50-0.95); for people without T2DM, HR was 1.09 (95%CI: 0.88-1.34)(Pinteraction=0.019).
- With regard to effect modification by T2DM for recurrent HF hospitalization, the benefit of omega-3 fatty acids was more pronounced in people with T2DM (HR 0.53, 95%CI:0,41-0,69) than in those without T2DM (HR 1.07, 95%CI: 0,89-1,28)
- In the total population, supplementation with omega-3 fatty acids reduced the number of recurrent HF hospitalizations only in black people (HR 0.65, 95%CI:0.49-0.88), not in white. In patients with T2DM, reductions in recurrent HF hospitalizations with omega-3 fatty acids were seen in black participants (HR 0.46, 95%CI:0.30-0.70) as well as in white participants (HR 0.65, 95%CI:0.45-0.92).
The results of this post-hoc analysis show that omega-3 fatty acids have beneficial effects on the incidence of HF hospitalization in patients with T2DM and not in people without T2DM. The effect on recurrent HF hospitalization was especially pronounced in black patients with T2DM.