Effect of omega-3 fatty acids on cardiovascular outcomes: A systematic review and meta-analysis
Khan SU, Lone AN, Khan MS, Virani SS, Blumenthal RS, Nasir K, Miller M, Michos ED, Ballantyne CM, Boden WE, Bhatt DL
EClinicalMedicine · 255 citations
Review labels
Neutral facts our review recorded about how this study was done. They describe method, never whether we like the result.
How it was studied
- Design
- Meta-analysis (classified by our AI screen)
- Studied in
- People
- Main outcome
- Clinical events such as disease or death
Who paid for it
- Funding
- Independent funding
- Authors
- At least one author declares a financial tie to industry
Based on full-text disclosure statement.
Publication
- Published
- 2021-07-08 · EClinicalMedicine · vol. 38 · p. 100997
- Publisher
- Elsevier BV
- Cited
- 406 citations · more than 99% of similar papers · 11.1× the field average
- Impact
- Top 10% most cited in its field
- References
- 69 works
- Access
- Open access (journal) · CC-BY
- Research areas
- Fatty Acid Research and Health · Cardiac Valve Diseases and Treatments · Eicosanoids and Hypertension Pharmacology
- Keywords
- Medicine, Internal medicine, Meta-analysis, Mace, Myocardial infarction, Relative risk, Eicosapentaenoic acid, Docosahexaenoic acid, Cochrane Library, Randomized controlled trial, Adverse effect, Confidence interval, Polyunsaturated fatty acid, Fatty acid, Percutaneous coronary intervention
11 authors
From US
- Safi Ullah KhanWest Virginia University
- Ahmad Naeem LoneWest Virginia University
- Muhammad Shahzeb KhanUniversity of Mississippi Medical Center
- Salim S. ViraniMichael E. DeBakey VA Medical Center; Baylor College of Medicine
- Roger Scott BlumenthalJohns Hopkins University; Johns Hopkins Medicine
- Khurram NasirHouston Methodist
Abstract
Background
The effects of omega-3 fatty acids (FAs), such as eicosapentaenoic (EPA) and docosahexaenoic (DHA) acids, on cardiovascular outcomes are uncertain. We aimed to determine the effectiveness of omega-3 FAs on fatal and non-fatal cardiovascular outcomes and examine the potential variability in EPA vs. EPA+DHA treatment effects.
Methods
We searched EMBASE, PubMed, ClinicalTrials.gov, and Cochrane library databases through June 7, 2021. We performed a meta-analysis of 38 randomized controlled trials of omega-3 FAs, stratified by EPA monotherapy and EPA+DHA therapy. We estimated random-effects rate ratios (RRs) with (95% confidence intervals) and rated the certainty of evidence using GRADE. The key outcomes of interest were cardiovascular mortality, non-fatal cardiovascular outcomes, bleeding, and atrial fibrillation (AF). The protocol was registered in PROSPERO (CRD42021227580).
Findings
In 149,051 participants, omega-3 FA was associated with reducing cardiovascular mortality (RR, 0.93 [0.88-0.98]; p = 0.01), non-fatal myocardial infarction (MI) (RR, 0.87 [0.81-0.93]; p = 0.0001), coronary heart disease events (CHD) (RR, 0.91 [0.87-0.96]; p = 0.0002), major adverse cardiovascular events (MACE) (RR, 0.95 [0.92-0.98]; p = 0.002), and revascularization (RR, 0.91 [0.87-0.95]; p = 0.0001). The meta-analysis showed higher RR reductions with EPA monotherapy (0.82 [0.68-0.99]) than with EPA + DHA (0.94 [0.89-0.99]) for cardiovascular mortality, non-fatal MI (EPA: 0.72 [0.62-0.84]; EPA+DHA: 0.92 [0.85-1.00]), CHD events (EPA: 0.73 [0.62-0.85]; EPA+DHA: 0.94 [0.89-0.99]), as well for MACE and revascularization. Omega-3 FA increased incident AF (RR, 1.26 [1.08-1.48]). EPA monotherapy vs. control was associated with a higher risk of total bleeding (RR: 1.49 [1.20-1.84]) and AF (RR, 1.35 [1.10-1.66]).
Interpretation
Omega-3 FAs reduced cardiovascular mortality and improved cardiovascular outcomes. The cardiovascular risk reduction was more prominent with EPA monotherapy than with EPA+DHA.
Funding
None.
Abstract via Europe PMC. Copyright remains with the authors or publisher (CC BY).
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