Was ist gesichert, was obsolet… bei Vitaminen und ... · KORA Studie: Versorgung mit Vitaminen (Serum) Conzade et al, Prevalence and Predictors of Subclinical Micronutrient Deficiency

Was ist gesichert, was obsolet…

bei Vitaminen und Antioxidantien

PD Dr. med. Tanja Grammer

Dr. Grammer I MIPH I Folie 2

• Folsäure und Vitamin B 12

• Vitamin A und Carotenoide

• Omega-3-Fettsäuren

Gliederung


Frage 1: Wie häufig schätzen Sie, liegt eine subklinische Defizienz von

Vitamin D, Folsäure und Vitamin B12 im Serum bei Menschen

> 65 Jahre in der Allgemeinbevölkerung vor?

1.10%, 10%, 20%

2.30%, 20%, 10%

3.70%, 20%, 30%

4.50%, 10%, 30%


KORA Studie: Versorgung mit Vitaminen (Serum)

Conzade et al, Prevalence and Predictors of Subclinical Micronutrient Deficiency in German Older Adults:

Results from the Population-Based KORA-Age Study, Nutrients, 2017

https://www.ncbi.nlm.nih.gov/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Click%20on%20image%20to%20zoom&p=PMC3&id=5748727_nutrients-09-01276-g001.jpg

https://www.ncbi.nlm.nih.gov/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Click%20on%20image%20to%20zoom&p=PMC3&id=5748727_nutrients-09-01276-g001.jpg


De-Regil LM, Peña-Rosas JP, Fernández-Gaxiola AC, Rayco-Solon P. Effects and safety of periconceptional oral

folate supplementation for preventing birth defects.Cochrane Database of Systematic Reviews 2015, Issue 12.

Art. No.: CD007950. DOI: 10.1002/14651858.CD007950.pub3.


Vitamin B12

• Cochrane Review 2017:

Homocystein-lowering interventions

for preventing cardiovascular events

• Cochrane Review 2018:

Orale versus i.m. Gabe von Vitamin B12

bei Defizienz (< 200 pg/ml)


Frage 2: Was trifft für Carotenoide zu?

1. Vitamin A, Alpha- und Betacarotin werden ausschließlich über

pflanzliche Nahrungsmittel aufgenommen.

2. Eine Defizienz von Vitamin A kann zu Nachtblindheit, Xerophthalmie,

Anämie, Hautläsionen oder vermehrten Infektionen führen.

3. Die pflanzlichen Carotenoide Lycopen, Lutein und Zeaxanthin werden

im Organismus zu Vitamin A umgebaut.

4. Carotenoide sind nicht mit kardiovaskulärer Mortalität assoziiert.


Quellen von Vitamin A and Carotenoiden

Tierische

Nahrungsmittel

• Leber

• Eier

• Butter

• Käse

• Milch

• Fisch

• Fleisch

Pflanzliche Nahrungsmittel

• Spinat

• Salat

• Kürbis

• Curry

• Tomaten

• Mangos

• Papaya


Lycopen, Lutein, Zeaxanthin

Carotenoide, nicht zu Vitamin A umgewandelt

Tomaten, Spinat, Feldsalat, Broccoli

Antioxidative und photoprotektive Eigenschaften

Schutz vor altersabhängiger Maculadegeneration


Grammer et al. In preparation

LURIC: Retinol und Gesamtmortalität

Quartile



LURIC: Carotenoide und Gesamtmortalität

Quartile Quartile



Lycopene und Lutein/Zeaxanthine und Gesamtmortalität

Quartile Quartile


NHANES: Vitamin A und Mortalität

• 16,008 Teilnehmer der

• NHANES III (1988–1994) Studie

• 14.2 Jahre follow-up

• Multivariate Adjustierung

Goyal A et al. Cancer Epidemiol Biomarkers

Prev 2013;22:2202-2211


Bjelakovic et al, Cochrane systematic review 2012

Cochrane Reviews

Keine Evidenz, dass antioxidative Supplemente

Mortalität reduzieren.

Beta-carotene, Vitamin E und Vitamin A

scheinen die Sterblichkeit zu erhöhen.

Antioxidant vitamin and mineral supplements for slowing the

progression of age‐related macular degenerationEvans et al, Cochrane Systematic Review, 2017


3. Frage: Omega-3-Fettsäuren- Was trifft zu?

1. Omega-3 Fettsäuren pflanzlicher und tierischer Herkunft sind

biologisch gleichwertig.

2. Die regelmäßige Einnahme von Omega-3-Fettsäuren ist mit

verminderter kardiovaskulärer Mortalität assoziiert.

3. Der Omega-3-Index wird im Serum bestimmt.

4. Ein höherer Omega-3-Index ist nicht mit einem niedrigeren Blutdruck

assoziiert.


Women´s Health Initiative Memory Study

Harris et al, J Clin Lipidol; 2017

>6000 postmenopausale Frauen > 65 Jahre, 15 Jahre Follow-up


Omega-3- Fettsäuren und Blutdruck

GAPP - Populationsbasierte Kohorte, 2170 Erwachsene (25-41 Jahre)

Filipovic et al, Whole blood omega-3 fatty acid concentrations are inversely associated with blood pressure in young, healthy adults. J Hypetension, 2018


Omega-3-Fettsäuren und Mortalität- Meta-Analyse

Maki et al, Use of supplemental long-chain omega-3 fatty acids and risk for cardiac death: An updated

meta-analysis and review of research gapsJournal of Clinical Lipidology, 2017


Cochrane systematic review: Omega-3-Fettsäuren

zur primären und sekundären kardiovaskulären

Prävention

Authors' conclusions

Moderate‐ and high‐quality evidence suggests that increasing EPA and

DHA has little or no effect on mortality or cardiovascular health (evidence

mainly from supplement trials)….

Abdelhamid et al, Omega‐3 fatty acids for the primary and secondary prevention of cardiovascular disease, Cochrane systematic review, 2018


ASCEND Studie

ASCEND Study Collaborative Group. Effects of n-3 Fatty Acid Supplements in Diabetes Mellitus. N Engl J Med. 2018 Aug 26

15.000 Personen mit Diabetes, 1g EPA+DHA, 7,4 Jahre Follow-up


REDUCE-IT

Bhatt et al, Rationale and design of REDUCE‐IT:

Reduction of Cardiovascular Events with Icosapent Ethyl–Intervention Trial,

Clin. Cardiol., 2017

REDUCE-IT™ Cardiovascular Outcomes Study of Vascepa® (icosapent ethyl) Capsules Met Primary

EndpointSeptember 24, 2018REDUCE-IT Is First Outcomes Study to Assess Treatment of Patients with LDL-C Controlled by Statin Therapy, Persistent Elevated

Triglycerides and Other Cardiovascular Risk Factors

Results Specific to Pure EPA Vascepa at 4 Grams Daily

Conference Call Scheduled for Today, Monday, September 24, 2018 at 8:00 am ET

BEDMINSTER, N.J. and DUBLIN, Ireland, Sept. 24, 2018 (GLOBE NEWSWIRE) -- Amarin Corporation plc (NASDAQ:AMRN), announced today

topline results from the Vascepa® cardiovascular (CV) outcomes trial, REDUCE-IT™, a global study of 8,179 statin-treated adults with elevated CV

risk. REDUCE-IT met its primary endpoint demonstrating an approximately 25% relative risk reduction, to a high degree of statistical significance

(p<0.001), in major adverse CV events (MACE) in the intent-to-treat patient population with use of Vascepa 4 grams/day as compared to placebo.

Patients enrolled in REDUCE-IT had LDL-C between 41-100 mg/dL (median baseline LDL-C 75 mg/dL) controlled by statin therapy and various

cardiovascular risk factors including persistent elevated triglycerides (TGs) between 150-499 mg/dL (median baseline 216 mg/dL) and either

established cardiovascular disease (secondary prevention cohort) or diabetes mellitus and at least one other CV risk factor (primary prevention

cohort).

Key topline results include:

Efficacy: Approximately 25% relative risk reduction, demonstrated to a high degree of statistical significance (p<0.001), in

the primary endpoint composite of the first occurrence of MACE, including cardiovascular death, nonfatal myocardial

infarction (MI), nonfatal stroke, coronary revascularization, or unstable angina requiring hospitalization. This result was

supported by robust demonstrations of efficacy across multiple secondary endpoints.

Safety: Vascepa was well tolerated with a safety profile consistent with clinical experience associated with omega-3 fatty

acids and current FDA-approved labeling. The proportions of patients experiencing adverse events and serious adverse

events in REDUCE-IT were similar between the active and placebo treatment groups. Median follow-up time in

REDUCE-IT was 4.9 years.Amarin is eager to share REDUCE-IT data in greater detail with both the medical community and regulatory authorities. REDUCE-IT results have been

accepted for presentation at the 2018 Scientific Sessions of the American Heart Association (AHA) on November 10, 2018 in Chicago, Illinois. The

presentation, classified as late breaking clinical trial results, is scheduled to commence at 2:16 pm Central Time and listed as Main Event 1 for the time

frame. This acceptance as a presentation of late-breaking clinical trial results was granted based on the ability of REDUCE-IT to address a critical

question in cardiovascular prevention.


Schlussfolgerungen

• Magere Studienlage

• Viele kleine Studien

• Heterogenität (Konzentrationen, Kombinationen, Beobachtungszeit)

• Folsäuesupplementierung evidenzbasiert

• Vitamin B12 bei nachgewiesenem Mangel auch oral

• Vitamin A, Carotenoide in Nahrungsmittel bevorzugen

• Omega-3-Fettsäuren reduzieren kardiovaskuläre Ereignisse

Documents

Was ist gesichert, was obsolet… bei Vitaminen und ... · KORA Studie: Versorgung mit Vitaminen (Serum) Conzade et al, Prevalence and Predictors of Subclinical Micronutrient Deficiency