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Omega 3 Fatty acids and cardiovascular outcomes: systematic review and meta-analysis.
Circ Cardiovasc Qual Outcomes 2012; 5(6):808-18CC

Abstract

BACKGROUND

Early trials evaluating the effect of omega 3 fatty acids (ω-3 FA) reported benefits for mortality and cardiovascular events but recent larger studies trials have variable findings. We assessed the effects of ω-3 FA on cardiovascular and other important clinical outcomes.

METHODS AND RESULTS

We searched MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials for all randomized studies using dietary supplements, dietary interventions, or both. The primary outcome was a composite of cardiovascular events (mostly myocardial infarction, stroke, and cardiovascular death). Secondary outcomes were arrhythmia, cerebrovascular events, hemorrhagic stroke, ischemic stroke, coronary revascularization, heart failure, total mortality, nonvascular mortality, and end-stage kidney disease. Twenty studies including 63030 participants were included. There was no overall effect of ω-3 FA on composite cardiovascular events (relative risk [RR]=0.96; 95% confidence interval [CI], 0.90-1.03; P=0.24) or on total mortality (RR=0.95; 95% CI, 0.86-1.04; P=0.28). ω-3 FA did protect against vascular death (RR=0.86; 95% CI, 0.75-0.99; P=0.03) but not coronary events (RR=0.86; 95% CI, 0.67-1.11; P=0.24). There was no effect on arrhythmia (RR=0.99; 95% CI, 0.85-1.16; P=0.92) or cerebrovascular events (RR=1.03; 95% CI, 0.92-1.16; P=0.59). Adverse events were more common in the treatment group than the placebo group (RR=1.18, 95% CI, 1.02-1.37; P=0.03), predominantly because of an excess of gastrointestinal side effects.

CONCLUSIONS

ω-3 FA may protect against vascular disease, but the evidence is not clear-cut, and any benefits are almost certainly not as great as previously believed.

Authors+Show Affiliations

George Institute for Global Health, University of Sydney, Sydney, Australia. skotwal@georgeinstitute.org.auNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Meta-Analysis
Research Support, Non-U.S. Gov't
Review
Systematic Review

Language

eng

PubMed ID

23110790

Citation

Kotwal, Sradha, et al. "Omega 3 Fatty Acids and Cardiovascular Outcomes: Systematic Review and Meta-analysis." Circulation. Cardiovascular Quality and Outcomes, vol. 5, no. 6, 2012, pp. 808-18.
Kotwal S, Jun M, Sullivan D, et al. Omega 3 Fatty acids and cardiovascular outcomes: systematic review and meta-analysis. Circ Cardiovasc Qual Outcomes. 2012;5(6):808-18.
Kotwal, S., Jun, M., Sullivan, D., Perkovic, V., & Neal, B. (2012). Omega 3 Fatty acids and cardiovascular outcomes: systematic review and meta-analysis. Circulation. Cardiovascular Quality and Outcomes, 5(6), pp. 808-18. doi:10.1161/CIRCOUTCOMES.112.966168.
Kotwal S, et al. Omega 3 Fatty Acids and Cardiovascular Outcomes: Systematic Review and Meta-analysis. Circ Cardiovasc Qual Outcomes. 2012;5(6):808-18. PubMed PMID: 23110790.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Omega 3 Fatty acids and cardiovascular outcomes: systematic review and meta-analysis. AU - Kotwal,Sradha, AU - Jun,Min, AU - Sullivan,David, AU - Perkovic,Vlado, AU - Neal,Bruce, Y1 - 2012/10/30/ PY - 2012/11/1/entrez PY - 2012/11/1/pubmed PY - 2013/3/13/medline SP - 808 EP - 18 JF - Circulation. Cardiovascular quality and outcomes JO - Circ Cardiovasc Qual Outcomes VL - 5 IS - 6 N2 - BACKGROUND: Early trials evaluating the effect of omega 3 fatty acids (ω-3 FA) reported benefits for mortality and cardiovascular events but recent larger studies trials have variable findings. We assessed the effects of ω-3 FA on cardiovascular and other important clinical outcomes. METHODS AND RESULTS: We searched MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials for all randomized studies using dietary supplements, dietary interventions, or both. The primary outcome was a composite of cardiovascular events (mostly myocardial infarction, stroke, and cardiovascular death). Secondary outcomes were arrhythmia, cerebrovascular events, hemorrhagic stroke, ischemic stroke, coronary revascularization, heart failure, total mortality, nonvascular mortality, and end-stage kidney disease. Twenty studies including 63030 participants were included. There was no overall effect of ω-3 FA on composite cardiovascular events (relative risk [RR]=0.96; 95% confidence interval [CI], 0.90-1.03; P=0.24) or on total mortality (RR=0.95; 95% CI, 0.86-1.04; P=0.28). ω-3 FA did protect against vascular death (RR=0.86; 95% CI, 0.75-0.99; P=0.03) but not coronary events (RR=0.86; 95% CI, 0.67-1.11; P=0.24). There was no effect on arrhythmia (RR=0.99; 95% CI, 0.85-1.16; P=0.92) or cerebrovascular events (RR=1.03; 95% CI, 0.92-1.16; P=0.59). Adverse events were more common in the treatment group than the placebo group (RR=1.18, 95% CI, 1.02-1.37; P=0.03), predominantly because of an excess of gastrointestinal side effects. CONCLUSIONS: ω-3 FA may protect against vascular disease, but the evidence is not clear-cut, and any benefits are almost certainly not as great as previously believed. SN - 1941-7705 UR - https://www.unboundmedicine.com/medline/citation/23110790/Omega_3_Fatty_acids_and_cardiovascular_outcomes:_systematic_review_and_meta_analysis_ L2 - http://www.ahajournals.org/doi/full/10.1161/CIRCOUTCOMES.112.966168?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -