Long-term supplementation with vitamin D3 (cholecalciferol) does not improve cardiovascular or cancer outcomes among patients with and without chronic kidney disease, according to an oral presentation at the American Society of Nephrology’s Kidney Week 2022.
In the Vitamin D and Omega-3 Trial (VITAL), investigators randomly assigned 15,917 participants to daily 2000 IU vitamin D3 and/or 1 g omega-3 fatty acids, or placebo. Men were aged 50 years or older and women were aged 55 years or older. None had cardiovascular disease or cancer at baseline.
In a subset of patients with measurements, vitamin D3 supplementation increased serum 25(OH)D levels by a mean 12.6 ng/mL more than placebo, with no meaningful differences by estimated glomerular filtration rate (eGFR; in mL/min/1.73 m2), Christine P. Limonte, MD, of the University of Washington in Seattle reported for her team. Parathyroid hormone (PTH) levels decreased significantly more with vitamin D3 vs placebo, especially in patients with lower eGFR: -6.9, -5.8, -4.0, and -3.8 pg/mL at an eGFR less than 60, 60 to 74, 75 to 89, and more than 90, respectively.
Over a median 5.3 years, major adverse cardiovascular events (MACE; defined as myocardial infarction, cardiac arrest, or cardiovascular death) occurred in 508 patients (3%) and invasive cancer in 1051 patients (7%). Generally, the risk for MACE significantly increased 75% and 33% among patients with an eGFR less than 60 and 60 to 74, respectively, compared with an eGFR of 90 or more. Cancer risk did not differ significantly by eGFR categories.
Despite substantial increases in circulating 25(OH)D and decreases in PTH concentrations with vitamin D3 supplementation, MACE and cancer risks did not improve significantly within any eGFR category with vitamin D3 treatment, Dr Limonte reported.
Rates of adverse events, such as hypercalcemia and kidney stones, were comparable between groups.
Limonte CP, Zelnick LR, Hoofnagle AN, et al. Effects of vitamin D3 supplementation on cardiovascular and cancer outcomes by estimated glomerular filtration rate in the vitamin D and omega-3 trial. Presented at: Kidney Week 2022; November 3-6, Orlando, Florida. Abstract SA-PO187.