VITAL Rhythm Study

• ClinicalTrials.gov Identifier: NCT02178410
• Recruitment Status: Active, not recruiting
• First Posted: June 30, 2014
• Last Update Posted: October 23, 2020
• Sponsor: Brigham and Women's Hospital
• Collaborator: National Heart, Lung, and Blood Institute (NHLBI)
• Information provided by (Responsible Party): Christine M. Albert, MD, MPH, Brigham and Women's Hospital

Study Description

Brief Summary:

The VITamin D and OmegA-3 TriaL (VITAL) is an ongoing randomized clinical trial of 25,871 U.S. men and women investigating whether taking daily dietary supplements of vitamin D3 (2000 IU) or omega-3 fatty acids (Omacor® fish oil, 1 gram) reduces the risk of developing cancer, heart disease, and stroke in individuals who do not have a prior history of these illnesses. The purpose of this ancillary study is to ascertain and adjudicate atrial fibrillation (AF) outcomes for the primary aim of testing whether omega-3 fatty acid and/or vitamin D supplementation influence atrial fibrillation risk in the general population. We also plan to examine how these agents might impact the development of AF subtypes (persistent versus paroxysmal), intermediate phenotypes for heart rhythm disorders (electrocardiographic parameters), as well as explore effects on arrhythmic death and whether baseline blood levels and/or race modify treatment effects.

Condition or disease	Intervention/treatment	Phase
Cardiovascular Disease	Dietary Supplement: Vitamin D3; Drug: Omega-3 fatty acids (fish oil); Dietary Supplement: Fish oil placebo; Dietary Supplement: Vitamin D3 placebo	Phase 3

Detailed Description:

Atrial fibrillation and sudden cardiac death assessments, as well as blood analyses, will be conducted on the entire VITAL Study population, and ECG analyses will be limited to the Clinical and Translational Science Center (CTSC) sub-cohort of 1,054 VITAL participants who live near the Boston area and agree to participate in a series of ancillary studies in addition to the main trial.

Investigators will ascertain atrial fibrillation events utilizing self-report of physician diagnoses of atrial fibrillation received on annual questionnaires from study participants supplemented by outpatient and hospital visits for AF identified through Centers for Medicare and Medicaid Services (CMS) data linkage. Investigators will also ascertain additional information regarding atrial fibrillation diagnosis from supplementary questionnaires, and seek consent to review all inpatient and outpatient hospital records pertaining to atrial fibrillation diagnosis and evaluation. Atrial fibrillation events will be confirmed by an endpoint committee composed of cardiologists, which will also make a determination on atrial fibrillation subtype and pattern. Questionnaires that inquire about recurrent atrial fibrillation events, pattern of AF, latest medical record evaluation and treatments for AF will be sent to participants with confirmed atrial fibrillation. Medical records will be requested and reviewed an endpoint committee to determine atrial fibrillation subtype and progression. An intention-to-treat analysis examining the 5-year treatment effects of omega-3 fatty acids and vitamin D on incident atrial fibrillation, as well as subtypes at the time of diagnosis will be performed to address the primary aims. We will repeat these analyses at the end of extended follow-up to assess cumulative and post-treatment effects of omega-3 fatty acids and vitamin D and AF subtypes two years after diagnosis.

Electrocardiograms will be obtained at baseline and again after two years of treatment and follow-up among a sub-cohort of 1,054 patients being enrolled in VITAL at the CTSC. Investigators will utilize these ECG data to evaluate whether treatment with omega-3 fatty acids and vitamin D3 have significant effects on ECG measures. The ECGs will also be utilized to estimate the prevalence of asymptomatic persistent atrial fibrillation in our population not detected by our atrial fibrillation surveillance methods.

Investigators will examine baseline blood samples for participants with confirmed atrial fibrillation for the purpose of exploring whether the effect of vitamin D3 or fish oil supplementation on atrial fibrillation risk varies by the baseline blood levels of these nutrients.

Investigators will also seek additional information necessary to classify deaths as sudden or arrhythmic in origin, and cardiac deaths will be reviewed by an endpoint committee of cardiologists. Once these results have been compiled investigators will explore whether omega-3 fatty acids and/or vitamin D might have an effect on sudden and/or arrhythmic cardiac death.

Study Design

• Study Type: Interventional (Clinical Trial)
• Actual Enrollment: 25871 participants
• Allocation: Randomized
• Intervention Model: Factorial Assignment
• Masking: Triple (Participant, Investigator, Outcomes Assessor)
• Primary Purpose: Prevention
• Official Title: Vitamin D and Omega-3 Trial (VITAL Rhythm Study)
• Study Start Date: October 2012
• Estimated Primary Completion Date: April 2021
• Estimated Study Completion Date: April 2021

Arms and Interventions

Arm	Intervention/treatment
Active Comparator: Vitamin D + fish oil	Dietary Supplement: Vitamin D3; Vitamin D3 (cholecalciferol), 2000 IU per day.; Other Name: cholecalciferol; Drug: Omega-3 fatty acids (fish oil); Omacor, 1 capsule per day. Each capsule of Omacor contains 840 milligrams of marine omega-3 fatty acids (465 mg of eicosapentaenoic acid [EPA] and 375 mg of docosahexaenoic acid [DHA]).
Active Comparator: Vitamin D + fish oil placebo	Dietary Supplement: Vitamin D3; Vitamin D3 (cholecalciferol), 2000 IU per day.; Other Name: cholecalciferol; Dietary Supplement: Fish oil placebo; Fish oil placebo
Active Comparator: Vitamin D placebo + fish oil	Drug: Omega-3 fatty acids (fish oil); Omacor, 1 capsule per day. Each capsule of Omacor contains 840 milligrams of marine omega-3 fatty acids (465 mg of eicosapentaenoic acid [EPA] and 375 mg of docosahexaenoic acid [DHA]).; Dietary Supplement: Vitamin D3 placebo; Vitamin D3 placebo
Placebo Comparator: Vitamin D placebo + fish oil placebo	Dietary Supplement: Fish oil placebo; Fish oil placebo; Dietary Supplement: Vitamin D3 placebo; Vitamin D3 placebo

Outcome Measures

Primary Outcome Measures :

1. Atrial Fibrillation [ Time Frame: 7 years ]
   To assess whether omega-3 fatty acids (Omacor® 840 mg eicosapentaenoic acid (EPA) + docosahexaenoic acid (DHA) or vitamin D3 supplementation influences risk of atrial fibrillation in a general population of men and women without prior cardiovascular disease.

Secondary Outcome Measures :

1. Atrial Fibrillation [ Time Frame: 7 years ]
   To examine the short and long-term impacts of vitamin D3 and EPA+DHA supplementation on the development of AF subtypes.
2. Arrhythmic endpoints [ Time Frame: 5 years ]
   To examine the effect of vitamin D3 or EPA+DHA supplementation on electrocardiographic parameters to further understand mechanisms underlying associations with arrhythmic endpoints.

Other Outcome Measures:

1. Sudden Cardiac Death [ Time Frame: 5 years ]
   To explore effects of arrhythmic death and whether baseline blood levels and/or race modify treatment effects.

Eligibility Criteria

• Ages Eligible for Study: 50 Years and older (Adult, Older Adult)
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: Yes

Criteria

To be eligible this ancillary study participants must be enrolled in the Vitamin D and Omega-3 Trial (VITAL; National Clinical Trial (NCT) 01169259) and meet the following criteria:

Inclusion Criteria:

- physician diagnosis of atrial fibrillation after randomization

and/or

- cardiovascular death

Exclusion Criteria:

- physician diagnosis of atrial fibrillation prior to randomization

Contacts and Locations

Locations

United States, Massachusetts

Brigham and Women's Hospital

Boston, Massachusetts, United States, 02215

Sponsors and Collaborators

Brigham and Women's Hospital

National Heart, Lung, and Blood Institute (NHLBI)

Investigators

• Principal Investigator: Christine M. Albert, M.D., M.P.H.; Brigham and Women's Hospital

More Information

Additional Information:

Welcome to the VITAL Study website 

Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):

Albert CM, Cook NR, Pester J, Moorthy MV, Ridge C, Danik JS, Gencer B, Siddiqi HK, Ng C, Gibson H, Mora S, Buring JE, Manson JE. Effect of Marine Omega-3 Fatty Acid and Vitamin D Supplementation on Incident Atrial Fibrillation: A Randomized Clinical Trial. JAMA. 2021 Mar 16;325(11):1061-1073. doi: 10.1001/jama.2021.1489.

• Responsible Party: Christine M. Albert, MD, MPH, Principle Investigator, Brigham and Women's Hospital
• ClinicalTrials.gov Identifier: NCT02178410
• Other Study ID Numbers: R01HL116690 ( U.S. NIH Grant/Contract ); R01HL116690 ( U.S. NIH Grant/Contract ); 2012-P-002146 ( Other Identifier: Partners Human Research Committee )
• First Posted: June 30, 2014
• Last Update Posted: October 23, 2020
• Last Verified: October 2020

Keywords provided by Christine M. Albert, MD, MPH, Brigham and Women's Hospital:

Atrial Fibrillation; Vitamin D3; Omega-3 fatty acids; Fish oil

Additional relevant MeSH terms:

Cardiovascular Diseases; Vitamin D; Ergocalciferols; Cholecalciferol; Vitamins; Micronutrients; Physiological Effects of Drugs; Bone Density Conservation Agents; Calcium-Regulating Hormones and Agents