Vitamins and Mortality: An Interview With Jaakko Mursu

Linda Brookes, MSc; Jaakko Mursu, PhD


January 24, 2012

In This Article

The Finnish Vitamin D Trial (FIND)

Medscape: Supplementation with vitamin D has previously been shown to have a beneficial effect on mortality.[9,10,11] Such studies as the VITamin D and omegA-3 triaL (VITAL) trial in the United States are under way to investigate whether vitamin D supplementation reduces the risk for cardiovascular disease or cancer.

Dr. Mursu: Vitamin D could be an exception in that sense, but in our study, for some reason -- I do not know why -- we did not find any benefit for vitamin D. I know that from similar studies and even clinical trials, there is some evidence that it could help prevent cardiovascular disease, but as I said, it was an exception in our study.

However, the theory is that because vitamin D is formed with the help of the sun, the further north you go, the more likely you are to be lacking in vitamin D. In such countries as Finland, where there are long periods during which the sun is hardly visible above the horizon at all, most people could be vitamin D deficient. So at the University of Eastern Finland in Kuopio, we are just starting a large-scale trial, the Finnish Vitamin D Trial (FIND), to determine whether vitamin D supplementation helps in the primary prevention of cardiovascular and cancer -- because if it helps anywhere, Finland would be the place to study that.

Medscape: That will be a randomized clinical trial?

Dr. Mursu: FIND will be a large-scale clinical trial that will start recruiting participants in early 2012.[12] It will be conducted by the University of Eastern Finland in Kuopio and funded by the Academy of Finland, University of Eastern Finland, the Juho Vainio Foundation, and the Finnish Foundation for Cardiovascular Research. We need to recruit about 20,000 people, men older than 60 years and women older than 65 years, to tackle this issue. They will be randomized to 3 groups of daily supplementation with either 40 µg/day (1600 IU) or 80 µg/day (3200 IU) of vitamin D3 or placebo. Adherence, use of nonstudy drugs or supplements, diet, development of endpoints, and cardiovascular disease and cancer risk factors will be assessed by questionnaires. We will collect blood samples to assess effect modification by baseline 25-hydroxyvitamin D, and for future studies of genetic and biochemical hypotheses. Event data will be obtained by record linkage from the national computerized hospitalization registry. Trials such as this are needed, despite the high costs, to reliably determine whether there is an effect or not. Otherwise, observational studies have too many limitations to provide definite proof about whether supplements are effective or not.

Medscape: How long should a trial like that last?

Dr. Mursu: Usually a minimum of 5 years, as in the FIND study. Ten years would be better. Of course, usually for studies like that, you have to recruit people who are a little older. It is a kind of mathematical fact that you need enough people who get sick during the study to see the effects; that is the reason why most of the studies are done with older people. The young tend to stay healthier despite what they do, so if they seem to be lacking in a number of nutrients, they still manage somehow to stay well, although they usually pay the price later in later life.

Medscape: Will you be returning to Finland to work on the FIND trial?

Dr. Mursu: I am going to help our group to launch the trial, and I am going to study this issue further. I will continue to work on whether the quality of the diet would affect the outcome. The plan is to go back and forth between Finland and the United States and continue this collaboration. The study we just published was a unique opportunity to study diet and vitamins.


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