Background: Research suggest that vitamin K may have protective effects against
non-communicable and age-related diseases as diverse as cardiovascular disease (CVD),
osteoporosis, and type 2 diabetes (T2D). However, there is a need for larger studies
investigating the potential health effects of vitamin K in the general population.
Objective: The objective of the InterVitaminK trial is to investigate the effects of vitamin
K (menaquinone-7, MK-7) supplementation on cardiovascular, metabolic, and bone health.
Hypothesis: The primary hypothesis is that vitamin K supplementation will reduce the
progression of coronary artery calcification (CAC) with 15% compared with placebo.
Methods: The InterVitaminK trial is a double-blinded, placebo-controlled, randomized
intervention trial. The trial will be conducted in Denmark at the Center for Clinical
Research and Prevention and the CT scans will be performed at Rigshospitalet, Denmark.
Participants from the Inter99 cohort with detectable CAC (Agatson score >=10) are eligible
for the trial. Participants will be randomized 1:1 to receive one daily tablet with MK-7 or
placebo for a period of 3 years. Randomization is done in blocks of 6 using computer
generated random numbers. Participants are invited for a health examination at baseline and
after 1, 2, and 3 years intervention. CT scans are performed at baseline and at 3-year
follow-up.
Outcomes: The primary study outcome is progression of CAC from baseline to 3-year follow-up,
assessed by Cardiac CT scans. Secondary outcomes are bone mineral density, pulmonary
function, and biomarkers of insulin resistance.
Power: Power calculation and sample size considerations are based on the primary endpoint
(three-year progression in CAC). A total of 450 participants will be enrolled in the trial.
Based on a previous vitamin K trial and data from the Danish cohort study DANCAVAS, it is
assumed that the geometric mean three-year progression in CAC in the control group
participants is 3.0 with an SD of 1.3. The hypothesis is that vitamin K supplementation can
reduce the three-year progression in CAC by 15%. With an estimated dropout-rate of 25% during
the study period, a total of 450 participants (225 participants in each group) enrolled at
baseline, will provide 89% power to demonstrate an effect of at least 15% (alpha 0.05).
Statistical analyses: The effect of vitamin K supplementation on the primary outcome (CAC)
will be analyzed using mixed effects linear regression. The mixed effects linear regression
will include a fixed effect for group allocation (intervention/control), a fixed effect for
time point (baseline and 3-year follow-up), fixed effect for baseline CAC score and an
interaction between group allocation and time point. As baseline measurements are conducted
prior to enrolment, treatment at baseline will be modelled as a common treatment category,
constraining baseline measurements to no systematic treatment effect between the two arms.
The mixed effects model will include a random intercept for each enrolled participant and a
first order autoregressive correlation structure allowing correction of measurement for the
same participant with higher correlation for measurements closer in time.
Likewise, secondary outcomes and supportive outcomes will be analyzed using mixed effects
linear regression. Analysis and presentation of data will be in accordance with the CONSORT
guidelines. For details, see the statistical analysis plan uploaded at clinicaltrials.gov
(NCT05259046).