{"doi":"10.3390/nu15194235","title":"Marine n−3 Fatty Acids and Prevention of Cardiovascular Disease: A Novel Analysis of the VITAL Trial Using Win Ratio and Hierarchical Composite Outcomes","abstract":"This study aimed to investigate whether n−3 fatty acid supplementation reduced cardiovascular disease (CVD) events in a novel analysis using hierarchical composite CVD outcomes based on win ratio in the VITamin D and OmegA-3 TriaL (VITAL). This was a secondary analysis of our VITAL randomized trial, which assessed the effects of marine n−3 fatty acids (1 g/day) and vitamin D3 on incident CVD and cancer among healthy older adults (n = 25,871). The primary analysis estimated win ratios of a composite of major CVD outcomes prioritized as fatal coronary heart disease, other fatal CVD including stroke, non-fatal myocardial infarction (MI), and non-fatal stroke, comparing n−3 fatty acids to placebo. The primary result was a nonsignificant benefit of this supplementation for the prioritized primary CVD outcome (reciprocal win ratio [95% confidence interval]: 0.90 [0.78–1.04]), similar to the 0.92 (0.80–1.06) hazard ratio in our original time-to-first event analysis without outcome prioritization. Its benefits came from reducing MI (0.71 [0.57–0.88]) but not stroke (1.01 [0.80 to 1.28]) components. For the primary CVD outcome, participants with low fish consumption at baseline benefited (0.79 [0.65–0.96]) more than those with high consumption (1.05 [0.85–1.30]). These results are consistent with, but slightly stronger than, those without outcome prioritization.","journal":"Nutrients","year":2023,"id":355879,"datarank":0.26876392038420827,"base_score":1.791759469228055,"endowment":1.791759469228055,"self_citation_contribution":0.26876392038420827,"citation_network_contribution":0.0,"self_endowment_contribution":0.26876392038420827,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":5,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9593,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2023-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":11268,"name":"JoAnn E. Manson","orcid":"0000-0002-9426-7595","position":1,"is_corresponding":false},{"id":6854,"name":"Jae H. Kang","orcid":"0000-0003-4812-0557","position":2,"is_corresponding":false},{"id":6430,"name":"Julie E. Buring","orcid":"0000-0003-2648-8692","position":3,"is_corresponding":false},{"id":20423,"name":"I‐Min Lee","orcid":"0000-0002-1083-6907","position":4,"is_corresponding":false},{"id":30050,"name":"Kunihiro Nishimura","orcid":"0000-0002-0639-0949","position":5,"is_corresponding":false},{"id":1104232,"name":"Yasuhiko Sakata","orcid":"0000-0001-6809-8487","position":6,"is_corresponding":false},{"id":33052,"name":"Jacqueline Suk Danik","orcid":null,"position":7,"is_corresponding":false},{"id":1104652,"name":"Denise D’Agostino","orcid":null,"position":8,"is_corresponding":false},{"id":351263,"name":"Samia Mora","orcid":"0000-0001-6283-0980","position":9,"is_corresponding":false},{"id":1029,"name":"Christine M. Albert","orcid":"0000-0002-2081-1121","position":10,"is_corresponding":false},{"id":232625,"name":"Nancy R. Cook","orcid":"0000-0002-9705-0842","position":11,"is_corresponding":false},{"id":323418,"name":"Soshiro Ogata","orcid":"0000-0002-0100-376X","position":0,"is_corresponding":true}],"reference_count":26,"raw_metadata":{"citation_network_status":"fetched"},"created_at":"2026-07-19T01:13:21.145955Z","pmid":"37836519","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}