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Effect of omega-3 supplements on plasma apolipoprotein C-III concentrations: a systematic review and meta-analysis of randomized controlled trials.
Ann Med 2018; 50(7):565-575AM

Abstract

BACKGROUND

Apolipoprotein C-III (apo C-III) is a key regulator of triglycerides metabolism. The aim of this meta-analysis was to assess the effect of fish omega-3 polyunsaturated fatty acids (PUFAs) on apo C-III levels.

METHODS

Randomized placebo-controlled trials investigating the impact of omega-3 on apo C-III levels were searched in PubMed-Medline, SCOPUS, Web of Science and Google Scholar. A random-effects model and generic inverse variance method were used for quantitative data synthesis. Sensitivity analysis was conducted using the leave-one-out method. A weighted random-effects meta-regression was performed to evaluate the impact of potential confounders on glycemic parameters.

RESULTS

This meta-analysis comprising 2062 subjects showed a significant reduction of apo C-III concentrations following treatment with omega-3 (WMD: -22.18 mg/L, 95% confidence interval: -31.61, -12.75, p < .001; I2: 88.24%). Subgroup analysis showed a significant reduction of plasma apo C-III concentrations by eicosapentaenoic acid (EPA) ethyl esters but not omega-3 carboxylic acids or omega-3 ethyl esters. There was a greater apo C-III reduction with only EPA as compared with supplements containing EPA and docosahexaenoic acid (DHA) or only DHA. A positive association between the apo C-III-lowering effect of omega-3 with baseline apo C-III concentrations and treatment duration was found.

CONCLUSIONS

This meta-analysis has shown that omega-3 PUFAs might significantly decrease apo C-III. Key messages Omega-3 PUFA supplements significantly reduce apo C-III plasma levels, particularly in hypertriglyceridemic patients when applied in appropriate dose (more than 2 g/day) Triglyceride (TG)-lowering effect is achieved via peroxisome proliferator-activated receptors α Further studies should address the effect of omega-3 PUFAs alone or with other lipid-lowering drugs in order to provide a final answer whether apo C-III could be an important target for prevention of cardiovascular disease New apo C-III antisense oligonucleotide drug (Volanesorsen) showed to be promising in decreasing elevated TGs by reducing levels of apo C-III mRNA.

Authors+Show Affiliations

a Biotechnology Research Center , Mashhad University of Medical Sciences , Mashhad , Iran.b Biomedical Research Unit , Mexican Social Security Institute , Durango , Mexico.c Department of Clinical Biochemistry, Royal Free Hospital Campus , University College London Medical School, University College London (UCL) , London , United Kingdom.d Unit of Internal Medicine, Angiology and Arteriosclerosis Diseases, Department of Medicine , University of Perugia , Perugia , Italy.e Department of Hypertension , WAM University Hospital in Lodz, Medical University of Lodz , Lodz , Poland. f Polish Mother's Memorial Hospital Research Institute (PMMHRI) , Lodz , Poland.g Centro Dislipidemie , A.S.S.T. Grande Ospedale Metropolitano Niguarda , Milan , Italy.h Department of Internal medicine, School of Medicine , University Hospital Center Zagreb, University of Zagreb , Zagreb , Croatia.

Pub Type(s)

Journal Article
Meta-Analysis
Systematic Review

Language

eng

PubMed ID

30102092

Citation

Sahebkar, Amirhossein, et al. "Effect of Omega-3 Supplements On Plasma Apolipoprotein C-III Concentrations: a Systematic Review and Meta-analysis of Randomized Controlled Trials." Annals of Medicine, vol. 50, no. 7, 2018, pp. 565-575.
Sahebkar A, Simental-Mendía LE, Mikhailidis DP, et al. Effect of omega-3 supplements on plasma apolipoprotein C-III concentrations: a systematic review and meta-analysis of randomized controlled trials. Ann Med. 2018;50(7):565-575.
Sahebkar, A., Simental-Mendía, L. E., Mikhailidis, D. P., Pirro, M., Banach, M., Sirtori, C. R., & Reiner, Ž. (2018). Effect of omega-3 supplements on plasma apolipoprotein C-III concentrations: a systematic review and meta-analysis of randomized controlled trials. Annals of Medicine, 50(7), pp. 565-575. doi:10.1080/07853890.2018.1511919.
Sahebkar A, et al. Effect of Omega-3 Supplements On Plasma Apolipoprotein C-III Concentrations: a Systematic Review and Meta-analysis of Randomized Controlled Trials. Ann Med. 2018;50(7):565-575. PubMed PMID: 30102092.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effect of omega-3 supplements on plasma apolipoprotein C-III concentrations: a systematic review and meta-analysis of randomized controlled trials. AU - Sahebkar,Amirhossein, AU - Simental-Mendía,Luis E, AU - Mikhailidis,Dimitri P, AU - Pirro,Matteo, AU - Banach,Maciej, AU - Sirtori,Cesare R, AU - Reiner,Željko, Y1 - 2018/09/29/ PY - 2018/8/14/pubmed PY - 2019/10/31/medline PY - 2018/8/14/entrez KW - Omega-3 fatty acids KW - PUFA KW - cardiovascular disease KW - coronary heart disease KW - docosahexaenoic acid KW - eicosapentaenoic acid SP - 565 EP - 575 JF - Annals of medicine JO - Ann. Med. VL - 50 IS - 7 N2 - BACKGROUND: Apolipoprotein C-III (apo C-III) is a key regulator of triglycerides metabolism. The aim of this meta-analysis was to assess the effect of fish omega-3 polyunsaturated fatty acids (PUFAs) on apo C-III levels. METHODS: Randomized placebo-controlled trials investigating the impact of omega-3 on apo C-III levels were searched in PubMed-Medline, SCOPUS, Web of Science and Google Scholar. A random-effects model and generic inverse variance method were used for quantitative data synthesis. Sensitivity analysis was conducted using the leave-one-out method. A weighted random-effects meta-regression was performed to evaluate the impact of potential confounders on glycemic parameters. RESULTS: This meta-analysis comprising 2062 subjects showed a significant reduction of apo C-III concentrations following treatment with omega-3 (WMD: -22.18 mg/L, 95% confidence interval: -31.61, -12.75, p < .001; I2: 88.24%). Subgroup analysis showed a significant reduction of plasma apo C-III concentrations by eicosapentaenoic acid (EPA) ethyl esters but not omega-3 carboxylic acids or omega-3 ethyl esters. There was a greater apo C-III reduction with only EPA as compared with supplements containing EPA and docosahexaenoic acid (DHA) or only DHA. A positive association between the apo C-III-lowering effect of omega-3 with baseline apo C-III concentrations and treatment duration was found. CONCLUSIONS: This meta-analysis has shown that omega-3 PUFAs might significantly decrease apo C-III. Key messages Omega-3 PUFA supplements significantly reduce apo C-III plasma levels, particularly in hypertriglyceridemic patients when applied in appropriate dose (more than 2 g/day) Triglyceride (TG)-lowering effect is achieved via peroxisome proliferator-activated receptors α Further studies should address the effect of omega-3 PUFAs alone or with other lipid-lowering drugs in order to provide a final answer whether apo C-III could be an important target for prevention of cardiovascular disease New apo C-III antisense oligonucleotide drug (Volanesorsen) showed to be promising in decreasing elevated TGs by reducing levels of apo C-III mRNA. SN - 1365-2060 UR - https://www.unboundmedicine.com/medline/citation/30102092/Effect_of_omega_3_supplements_on_plasma_apolipoprotein_C_III_concentrations:_a_systematic_review_and_meta_analysis_of_randomized_controlled_trials_ L2 - http://www.tandfonline.com/doi/full/10.1080/07853890.2018.1511919 DB - PRIME DP - Unbound Medicine ER -