Alpha Omega Trial: Study of Omega-3 Fatty Acids and Coronary Mortality

NCT ID: NCT00127452

Last Updated: 2010-07-07

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

4837 participants

Study Classification

INTERVENTIONAL

Study Start Date

2002-04-30

Study Completion Date

2010-06-30

Brief Summary

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The Alpha Omega Trial is a randomized, placebo-controlled, double-blind dietary intervention study in 4837 postmyocardial infarction patients in the Netherlands to examine whether incidence of cardiovascular diseases during 40 months of follow-up can be prevented by low doses of omega-3 polyunsaturated fatty acids. The key objectives are:

* to examine the effect of low-dose supplementation (400 mg/day) of eicosapentaenoic acid and docosahexaenoic acid on incidence of cardiovascular diseases; and
* to examine the effect of low-dose supplementation (2 g/day) of alpha-linolenic acid on incidence of cardiovascular diseases.

Detailed Description

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Whether dietary omega-3 (or n-3) polyunsaturated fatty acids are causally related to risk of cardiovascular diseases (CVD) is a major, unresolved question in preventive cardiology. Essential n-3 fatty acids are eicosapentaenoic acid (EPA; C20:5, n-3) and docosahexaenoic acid (DHA; C22:6, n-3) on one hand, and their parent compound alpha-linolenic acid (ALA; C18:3, n-3) on the other hand. The intake of n-3 fatty acids is below recommended levels in most Western populations. The Alpha Omega Trial is a randomized, double-blind, placebo-controlled study of the effect of low-dose supplementation of ALA and EPA-DHA on CVD. A total of 4837 Dutch men and women aged 60-80 years who had a myocardial infarction in the past 10 years are randomly allocated to 2 g/d of ALA, 400 mg/d of EPA-DHA, 2 g/d ALA + 400 mg/d EPA-DHA, or placebo, for 40 months. Increased intake of n-3 fatty acids is achieved through daily use of 20 g of margarine on bread. Margarines for all treatment groups are similar in taste and appearance. The primary outcome of the trial is 'major cardiovascular events', which comprises incident CVD and cardiac interventions (PCI and CABG) during follow-up. Secondary endpoints are incident CVD, fatal CVD, fatal CHD and all-causes mortality. Complete follow-up for vital status is achieved. Cause-specific mortality is coded by an independent Endpoint Adjudication Committee. Physical examination, blood sampling and data collection on diet and lifestyle are performed in all subjects at baseline, in 810 randomly selected subjects after 20 months of intervention, and in 58% of the cohort at the end of follow-up. Cardiovascular health, serious adverse events, lifestyle, fish intake and margarine use are monitored in all subjects by yearly telephone interviews. Compliance is continuously monitored by registration of margarine tubs. An objective biomarker of compliance (i.e. plasma n-3 fatty acids) is obtained in randomly selected subjects at baseline and after 20 and 40 months of intervention. The Alpha Omega Trial could provide a sound scientific basis for dietary recommendations on intake of ALA and EPA-DHA, in order to reduce the burden of cardiovascular diseases.

Conditions

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Cardiovascular Diseases

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

PREVENTION

Blinding Strategy

QUADRUPLE

Participants Caregivers Investigators Outcome Assessors

Study Groups

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EPA + DHA

Margarine spread that yields 400 mg of eicosapentaenoic acid (EPA) + docosahexaenoic acid (DHA) per day for average margarine use of 20 grams per day

Group Type EXPERIMENTAL

margarine spread

Intervention Type DIETARY_SUPPLEMENT

Daily use of margarine spread (approximately 20 grams) during 40 months

ALA

Margarine spread that yields 2 grams of alpha-linolenic acid (ALA) per day for average margarine use of 20 grams per day

Group Type EXPERIMENTAL

margarine spread

Intervention Type DIETARY_SUPPLEMENT

Daily use of margarine spread (approximately 20 grams) during 40 months

EPA + DHA plus ALA

Margarine spread that yields 400 mg of EPA + DHA per day plus 2 grams of ALA per day, for average margarine use of 20 grams per day

Group Type EXPERIMENTAL

margarine spread

Intervention Type DIETARY_SUPPLEMENT

Daily use of margarine spread (approximately 20 grams) during 40 months

Placebo

Margarine spread that contains no EPA, DHA or ALA (exchanged for oleic acid)

Group Type PLACEBO_COMPARATOR

margarine spread

Intervention Type DIETARY_SUPPLEMENT

Daily use of margarine spread (approximately 20 grams) during 40 months

Interventions

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margarine spread

Daily use of margarine spread (approximately 20 grams) during 40 months

Intervention Type DIETARY_SUPPLEMENT

Eligibility Criteria

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Inclusion Criteria

* Men and women
* Aged 60 through 80 y
* Verified clinically diagnosed myocardial infarction up to 10 y before randomization
* Written informed consent

Exclusion Criteria

* Living in a nursing home or other institution
* Participation in another scientific study
* Habitual margarine intake \< 10 g per day
* Habitual fish intake \> 150 g per day
* Habitual alcohol intake \> 6 drinks per day
* Use of fish oil capsules or other supplements containing omega-3 fatty acids
* Presence of cancer with \< 1 y of life expectancy
* Cognitive impairment, as indicated by the Mini Mental State Examination (score \<= 21)
* Unintended weight loss \> 5 kg in the past year
* Lack of facilities for cooled margarine storage at home
* Inability or unwillingness to comply with study procedures
Minimum Eligible Age

60 Years

Maximum Eligible Age

80 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Netherlands Heart Foundation

OTHER

Sponsor Role collaborator

National Heart, Lung, and Blood Institute (NHLBI)

NIH

Sponsor Role collaborator

Unilever R&D

INDUSTRY

Sponsor Role collaborator

Wageningen University

OTHER

Sponsor Role lead

Responsible Party

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Wageningen University

Principal Investigators

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Daan Kromhout, PhD MPH

Role: PRINCIPAL_INVESTIGATOR

Wageningen University, The Netherlands

Locations

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Medisch Centrum Alkmaar

Alkmaar, , Netherlands

Site Status

Flevo Ziekenhuis

Almere Stad, , Netherlands

Site Status

Meander Medisch Centrum

Amersfoort, , Netherlands

Site Status

Sint Lucas Andreas Ziekenhuis

Amsterdam, , Netherlands

Site Status

BovenIJ Ziekenhuis

Amsterdam, , Netherlands

Site Status

Slotervaartziekenhuis

Amsterdam, , Netherlands

Site Status

Gelre ziekenhuizen

Apeldoorn, , Netherlands

Site Status

Lievensberg Ziekenhuis

Bergen op Zoom, , Netherlands

Site Status

Rode Kruis Ziekenhuis

Beverwijk, , Netherlands

Site Status

IJsselland Ziekenhuis

Capelle aan den IJssel, , Netherlands

Site Status

Ziekenhuis Gelderse Vallei

Ede, , Netherlands

Site Status

Catharina Ziekenhuis

Eindhoven, , Netherlands

Site Status

Medisch Spectrum Twente

Enschede, , Netherlands

Site Status

St. Anna Ziekenhuis

Geldrop, , Netherlands

Site Status

Oosterscheldeziekenhuis

Goes, , Netherlands

Site Status

Ziekenhuis Hilversum

Hilversum, , Netherlands

Site Status

Diaconessenhuis

Leiden, , Netherlands

Site Status

Rijnland Ziekenhuis

Leiderdorp, , Netherlands

Site Status

Sint Antonius Ziekenhuis

Nieuwegein, , Netherlands

Site Status

Canisius Wilhelmina Ziekenhuis

Nijmegen, , Netherlands

Site Status

Erasmus MC

Rotterdam, , Netherlands

Site Status

Havenziekenhuis

Rotterdam, , Netherlands

Site Status

Haga Ziekenhuis, location Leyweg

The Hague, , Netherlands

Site Status

Bronovo Ziekenhuis

The Hague, , Netherlands

Site Status

Haga Ziekenhuis, location Sportlaan

The Hague, , Netherlands

Site Status

Twee Steden Ziekenhuis

Tilburg, , Netherlands

Site Status

Maxima Medisch Centrum

Veldhoven, , Netherlands

Site Status

Alysis Ziekenhuis

Velp, , Netherlands

Site Status

Wageningen University, Division of Human Nutrition

Wageningen, , Netherlands

Site Status

Zaans Medisch Centrum

Zaandam, , Netherlands

Site Status

't Lange Land ziekenhuis

Zoetermeer, , Netherlands

Site Status

Isala Klinieken

Zwolle, , Netherlands

Site Status

Countries

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Netherlands

References

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Geleijnse JM, Giltay EJ, Schouten EG, de Goede J, Oude Griep LM, Teitsma-Jansen AM, Katan MB, Kromhout D; Alpha Omega Trial Group. Effect of low doses of n-3 fatty acids on cardiovascular diseases in 4,837 post-myocardial infarction patients: design and baseline characteristics of the Alpha Omega Trial. Am Heart J. 2010 Apr;159(4):539-546.e2. doi: 10.1016/j.ahj.2009.12.033.

Reference Type BACKGROUND
PMID: 20362710 (View on PubMed)

Liu S, Soedamah-Muthu SS, van Meerten SC, Kromhout D, Geleijnse JM, Giltay EJ. Use of benzodiazepine and Z-drugs and mortality in older adults after myocardial infarction. Int J Geriatr Psychiatry. 2023 Jan;38(1):e5861. doi: 10.1002/gps.5861.

Reference Type DERIVED
PMID: 36514248 (View on PubMed)

Pertiwi K, Wanders AJ, Harbers MC, Kupers LK, Soedamah-Muthu SS, de Goede J, Zock PL, Geleijnse JM. Plasma and Dietary Linoleic Acid and 3-Year Risk of Type 2 Diabetes After Myocardial Infarction: A Prospective Analysis in the Alpha Omega Cohort. Diabetes Care. 2020 Feb;43(2):358-365. doi: 10.2337/dc19-1483. Epub 2019 Nov 14.

Reference Type DERIVED
PMID: 31727685 (View on PubMed)

Sijtsma FP, Soedamah-Muthu SS, de Goede J, Oude Griep LM, Geleijnse JM, Giltay EJ, de Boer MJ, Jacobs DR Jr, Kromhout D. Healthy eating and lower mortality risk in a large cohort of cardiac patients who received state-of-the-art drug treatment. Am J Clin Nutr. 2015 Dec;102(6):1527-33. doi: 10.3945/ajcn.115.112276. Epub 2015 Oct 21.

Reference Type DERIVED
PMID: 26490494 (View on PubMed)

Hoogeveen EK, Geleijnse JM, Kromhout D, Stijnen T, Gemen EF, Kusters R, Giltay EJ. Effect of omega-3 fatty acids on kidney function after myocardial infarction: the Alpha Omega Trial. Clin J Am Soc Nephrol. 2014 Oct 7;9(10):1676-83. doi: 10.2215/CJN.10441013. Epub 2014 Aug 7.

Reference Type DERIVED
PMID: 25104273 (View on PubMed)

Hoogeveen EK, Geleijnse JM, Kromhout D, van't Sant P, Gemen EF, Kusters R, Giltay EJ. No effect of n-3 fatty acids supplementation on NT-proBNP after myocardial infarction: the Alpha Omega Trial. Eur J Prev Cardiol. 2015 May;22(5):648-55. doi: 10.1177/2047487314536694. Epub 2014 May 30.

Reference Type DERIVED
PMID: 24879357 (View on PubMed)

Brouwer IA, Geleijnse JM, Klaasen VM, Smit LA, Giltay EJ, de Goede J, Heijboer AC, Kromhout D, Katan MB. Effect of alpha linolenic acid supplementation on serum prostate specific antigen (PSA): results from the alpha omega trial. PLoS One. 2013 Dec 11;8(12):e81519. doi: 10.1371/journal.pone.0081519. eCollection 2013.

Reference Type DERIVED
PMID: 24349086 (View on PubMed)

Hoogeveen EK, Geleijnse JM, Kromhout D, Giltay EJ. No effect of n-3 fatty acids on high-sensitivity C-reactive protein after myocardial infarction: the Alpha Omega Trial. Eur J Prev Cardiol. 2014 Nov;21(11):1429-36. doi: 10.1177/2047487313494295. Epub 2013 Jun 17.

Reference Type DERIVED
PMID: 23774275 (View on PubMed)

Eussen SR, Geleijnse JM, Giltay EJ, Rompelberg CJ, Klungel OH, Kromhout D. Effects of n-3 fatty acids on major cardiovascular events in statin users and non-users with a history of myocardial infarction. Eur Heart J. 2012 Jul;33(13):1582-8. doi: 10.1093/eurheartj/ehr499. Epub 2012 Feb 1.

Reference Type DERIVED
PMID: 22301766 (View on PubMed)

Kromhout D, Geleijnse JM, de Goede J, Oude Griep LM, Mulder BJ, de Boer MJ, Deckers JW, Boersma E, Zock PL, Giltay EJ. n-3 fatty acids, ventricular arrhythmia-related events, and fatal myocardial infarction in postmyocardial infarction patients with diabetes. Diabetes Care. 2011 Dec;34(12):2515-20. doi: 10.2337/dc11-0896.

Reference Type DERIVED
PMID: 22110169 (View on PubMed)

Giltay EJ, Geleijnse JM, Kromhout D. Effects of n-3 fatty acids on depressive symptoms and dispositional optimism after myocardial infarction. Am J Clin Nutr. 2011 Dec;94(6):1442-50. doi: 10.3945/ajcn.111.018259. Epub 2011 Oct 26.

Reference Type DERIVED
PMID: 22030221 (View on PubMed)

Geleijnse JM, Giltay EJ, Kromhout D. Effects of n-3 fatty acids on cognitive decline: a randomized, double-blind, placebo-controlled trial in stable myocardial infarction patients. Alzheimers Dement. 2012 Jul;8(4):278-87. doi: 10.1016/j.jalz.2011.06.002. Epub 2011 Oct 2.

Reference Type DERIVED
PMID: 21967845 (View on PubMed)

Kromhout D, Giltay EJ, Geleijnse JM; Alpha Omega Trial Group. n-3 fatty acids and cardiovascular events after myocardial infarction. N Engl J Med. 2010 Nov 18;363(21):2015-26. doi: 10.1056/NEJMoa1003603. Epub 2010 Aug 28.

Reference Type DERIVED
PMID: 20929341 (View on PubMed)

Related Links

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http://www.alphaomegatrial.com

Information site of the Alpha Omega Trial; statistical analysis plans are posted here

http://www.wur.nl

Wageningen University and Research Centre

http://www.vlaggraduateschool.nl/

The Graduate School VLAG, Wageningen, The Netherlands

http://www.hartstichting.nl

Netherlands Heart Foundation

Other Identifiers

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NHF-2000T401

Identifier Type: -

Identifier Source: secondary_id

L01.049

Identifier Type: -

Identifier Source: secondary_id

5R01HL076200

Identifier Type: NIH

Identifier Source: secondary_id

View Link

METC-ZWH 0552

Identifier Type: -

Identifier Source: org_study_id

NCT00139464

Identifier Type: -

Identifier Source: nct_alias

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