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维生素D补充剂与癌症和心血管疾病的预防
Vitamin D Supplements and Prevention of Cancer and Cardiovascular Disease


JoAnn E. Manson ... 心脑血管疾病 肿瘤 • 2019.01.03
相关阅读
• 补充维生素D——VITAL研究的结果 • 血浆25-羟维生素D浓度与患癌风险呈负相关 • 补充维生素D能否预防不良心血管事件 • 维生素D水平与乳腺癌结局之间的关系

摘要


背景

目前尚不清楚补充维生素D是否能降低癌症或心血管疾病的风险,来自随机试验的数据也有限。

 

方法

我们进行了一项全国性的随机、安慰剂对照试验,采用2×2析因设计,研究2,000 IU/d剂量的维生素D3(胆钙化醇)和1 g/d剂量的海洋n-3(也称为ω-3)脂肪酸用于预防美国≥50岁男性和≥55岁女性的癌症和心血管疾病。主要终点是任何类型的侵袭性癌症和主要心血管事件(心肌梗死、卒中或心血管原因死亡构成的复合终点)。次要终点包括特定部位癌症、癌症死亡和其他心血管事件。本文报告维生素D与安慰剂的比较结果。

 

结果

共有25,871名参与者接受了随机分组,其中包括5,106名黑种人参与者。补充维生素D并未与任一主要终点的较低风险相关。在5.3年的中位随访期间,1,617名参与者被诊断出癌症(维生素D组793人,安慰剂组824人;风险比,0.96;95%置信区间[CI],0.88~1.06;P=0.47)。805名参与者发生了主要心血管事件(维生素D组396人,安慰剂组409人;风险比,0.97;95% CI,0.85~1.12;P=0.69)。在次要终点分析中,风险比如下:癌症死亡(341例死亡),0.83(95% CI,0.67~1.02);乳腺癌,1.02(95% CI,0.79~1.31);前列腺癌,0.88(95% CI,0.72~1.07);结直肠癌,1.09(95% CI,0.73~1.62);主要心血管事件加冠状动脉血运重建构成的扩展复合终点,0.96(95% CI,0.86~1.08);心肌梗死,0.96(95% CI,0.78~1.19);卒中,0.95(95% CI,0.76~1.20);心血管原因死亡,1.11(95% CI,0.88~1.40)。在全因死亡(978例死亡)分析中,风险比为0.99(95% CI,0.87~1.12)。本研究未发现高钙血症或其他不良事件的超额危险度。

 

结论

补充维生素D并未使侵袭性癌症或心血管事件的发生率低于安慰剂(由美国国立卫生研究院等资助;VITAL在ClinicalTrials.gov注册号为NCT01169259)。





作者信息

JoAnn E. Manson, M.D., Dr.P.H., Nancy R. Cook, Sc.D., I-Min Lee, M.B., B.S., Sc.D., William Christen, Sc.D., Shari S. Bassuk, Sc.D., Samia Mora, M.D., M.H.S., Heike Gibson, Ph.D., David Gordon, M.A.T., Trisha Copeland, M.S., R.D., Denise D’Agostino, B.S., Georgina Friedenberg, M.P.H., Claire Ridge, M.P.H., Vadim Bubes, Ph.D., Edward L. Giovannucci, M.D., Sc.D., Walter C. Willett, M.D., Dr.P.H., and Julie E. Buring, Sc.D. for the VITAL Research Group*
From the Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School (J.E.M., N.R.C., I.-M.L., W.C., S.S.B., S.M., H.G., D.G., T.C., D.D., G.F., C.R., V.B., E.L.G., W.C.W., J.E.B.), and the Departments of Epidemiology (J.E.M., N.R.C., I.-M.L., W.C.W., J.E.B.) and Nutrition (E.L.G., W.C.W.), Harvard T.H. Chan School of Public Health — all in Boston. Address reprint requests to Dr. Manson at the Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, 900 Commonwealth Ave., 3rd Fl., Boston, MA 02215, or at jmanson@rics.bwh.harvard.edu. *A complete list of the members of the VITAL Research Group is provided in the Supplementary Appendix, available at NEJM.org.

 

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