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Association between omega-3 fatty acid supplementation and risk of major cardiovascular disease events: a systematic review and meta-analysis.

Abstract

CONTEXT

Considerable controversy exists regarding the association of omega-3 polyunsaturated fatty acids (PUFAs) and major cardiovascular end points.

OBJECTIVE

To assess the role of omega-3 supplementation on major cardiovascular outcomes.

DATA SOURCES

MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials through August 2012.

STUDY SELECTION

Randomized clinical trials evaluating the effect of omega-3 on all-cause mortality, cardiac death, sudden death, myocardial infarction, and stroke.

DATA EXTRACTION

Descriptive and quantitative information was extracted; absolute and relative risk (RR) estimates were synthesized under a random-effects model. Heterogeneity was assessed using the Q statistic and I2. Subgroup analyses were performed for the presence of blinding, the prevention settings, and patients with implantable cardioverter-defibrillators, and meta-regression analyses were performed for the omega-3 dose. A statistical significance threshold of .0063 was assumed after adjustment for multiple comparisons.

DATA SYNTHESIS

Of the 3635 citations retrieved, 20 studies of 68,680 patients were included, reporting 7044 deaths, 3993 cardiac deaths, 1150 sudden deaths, 1837 myocardial infarctions, and 1490 strokes. No statistically significant association was observed with all-cause mortality (RR, 0.96; 95% CI, 0.91 to 1.02; risk reduction [RD] -0.004, 95% CI, -0.01 to 0.02), cardiac death (RR, 0.91; 95% CI, 0.85 to 0.98; RD, -0.01; 95% CI, -0.02 to 0.00), sudden death (RR, 0.87; 95% CI, 0.75 to 1.01; RD, -0.003; 95% CI, -0.012 to 0.006), myocardial infarction (RR, 0.89; 95% CI, 0.76 to 1.04; RD, -0.002; 95% CI, -0.007 to 0.002), and stroke (RR, 1.05; 95% CI, 0.93 to 1.18; RD, 0.001; 95% CI, -0.002 to 0.004) when all supplement studies were considered.

CONCLUSION

Overall, omega-3 PUFA supplementation was not associated with a lower risk of all-cause mortality, cardiac death, sudden death, myocardial infarction, or stroke based on relative and absolute measures of association.

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  • Publisher Full Text
  • Authors+Show Affiliations

    ,

    Lipid Disorders Clinic, Department of Internal Medicine, University Hospital of Ioannina, Ioannina, Greece.

    , , ,

    Source

    JAMA 308:10 2012 Sep 12 pg 1024-33

    MeSH

    Aged
    Cardiovascular Diseases
    Cause of Death
    Death, Sudden, Cardiac
    Dietary Supplements
    Fatty Acids, Omega-3
    Humans
    Middle Aged
    Myocardial Infarction
    Randomized Controlled Trials as Topic
    Risk
    Stroke

    Pub Type(s)

    Journal Article
    Meta-Analysis
    Review
    Systematic Review

    Language

    eng

    PubMed ID

    22968891

    Citation

    Rizos, Evangelos C., et al. "Association Between Omega-3 Fatty Acid Supplementation and Risk of Major Cardiovascular Disease Events: a Systematic Review and Meta-analysis." JAMA, vol. 308, no. 10, 2012, pp. 1024-33.
    Rizos EC, Ntzani EE, Bika E, et al. Association between omega-3 fatty acid supplementation and risk of major cardiovascular disease events: a systematic review and meta-analysis. JAMA. 2012;308(10):1024-33.
    Rizos, E. C., Ntzani, E. E., Bika, E., Kostapanos, M. S., & Elisaf, M. S. (2012). Association between omega-3 fatty acid supplementation and risk of major cardiovascular disease events: a systematic review and meta-analysis. JAMA, 308(10), pp. 1024-33. doi:10.1001/2012.jama.11374.
    Rizos EC, et al. Association Between Omega-3 Fatty Acid Supplementation and Risk of Major Cardiovascular Disease Events: a Systematic Review and Meta-analysis. JAMA. 2012 Sep 12;308(10):1024-33. PubMed PMID: 22968891.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Association between omega-3 fatty acid supplementation and risk of major cardiovascular disease events: a systematic review and meta-analysis. AU - Rizos,Evangelos C, AU - Ntzani,Evangelia E, AU - Bika,Eftychia, AU - Kostapanos,Michael S, AU - Elisaf,Moses S, PY - 2012/9/13/entrez PY - 2012/9/13/pubmed PY - 2012/9/15/medline SP - 1024 EP - 33 JF - JAMA JO - JAMA VL - 308 IS - 10 N2 - CONTEXT: Considerable controversy exists regarding the association of omega-3 polyunsaturated fatty acids (PUFAs) and major cardiovascular end points. OBJECTIVE: To assess the role of omega-3 supplementation on major cardiovascular outcomes. DATA SOURCES: MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials through August 2012. STUDY SELECTION: Randomized clinical trials evaluating the effect of omega-3 on all-cause mortality, cardiac death, sudden death, myocardial infarction, and stroke. DATA EXTRACTION: Descriptive and quantitative information was extracted; absolute and relative risk (RR) estimates were synthesized under a random-effects model. Heterogeneity was assessed using the Q statistic and I2. Subgroup analyses were performed for the presence of blinding, the prevention settings, and patients with implantable cardioverter-defibrillators, and meta-regression analyses were performed for the omega-3 dose. A statistical significance threshold of .0063 was assumed after adjustment for multiple comparisons. DATA SYNTHESIS: Of the 3635 citations retrieved, 20 studies of 68,680 patients were included, reporting 7044 deaths, 3993 cardiac deaths, 1150 sudden deaths, 1837 myocardial infarctions, and 1490 strokes. No statistically significant association was observed with all-cause mortality (RR, 0.96; 95% CI, 0.91 to 1.02; risk reduction [RD] -0.004, 95% CI, -0.01 to 0.02), cardiac death (RR, 0.91; 95% CI, 0.85 to 0.98; RD, -0.01; 95% CI, -0.02 to 0.00), sudden death (RR, 0.87; 95% CI, 0.75 to 1.01; RD, -0.003; 95% CI, -0.012 to 0.006), myocardial infarction (RR, 0.89; 95% CI, 0.76 to 1.04; RD, -0.002; 95% CI, -0.007 to 0.002), and stroke (RR, 1.05; 95% CI, 0.93 to 1.18; RD, 0.001; 95% CI, -0.002 to 0.004) when all supplement studies were considered. CONCLUSION: Overall, omega-3 PUFA supplementation was not associated with a lower risk of all-cause mortality, cardiac death, sudden death, myocardial infarction, or stroke based on relative and absolute measures of association. SN - 1538-3598 UR - https://www.unboundmedicine.com/medline/citation/22968891/full_citation L2 - https://jamanetwork.com/journals/jama/fullarticle/10.1001/2012.jama.11374 DB - PRIME DP - Unbound Medicine ER -