학술논문
Effects of omega-3 fatty acids on coronary revascularization and cardiovascular events: a meta-analysis.
Document Type
Academic Journal
Author
Dinu M; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.; Sofi F; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.; Unit of Clinical Nutrition, Careggi University Hospital, Florence, Italy.; Lotti S; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.; Colombini B; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.; Mattioli AV; Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy.; Catapano AL; IRCCS MultiMedica, Milan, Italy.; Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy.; Casula M; IRCCS MultiMedica, Milan, Italy.; Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy.; Baragetti A; IRCCS MultiMedica, Milan, Italy.; Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy.; Wong ND; Division of Cardiology, University of California, Irvine, USA.; Steg PG; Université Paris-Cité, INSERM U1148, FACT French Alliance for Cardiovascular Trials, AP-HP Hopital Bichat, Paris, France.; Ambrosio G; Division of Cardiology, Center for Clinical and Translational Research-CERICLET, University of Perugia School of Medicine, Ospedale S. Maria della Misericordia, Via S. Andrea delle Fratte, 06156 Perugia, Italy.
Source
Publisher: Oxford University Press Country of Publication: England NLM ID: 101564430 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2047-4881 (Electronic) Linking ISSN: 20474873 NLM ISO Abbreviation: Eur J Prev Cardiol Subsets: MEDLINE
Subject
Language
English
Abstract
Aims: Benefits of pharmacologic omega-3 fatty acid administration in cardiovascular prevention are controversial. Particularly, effects on coronary revascularization are unclear; also debated are specific benefits of eicosapentaenoic acid (EPA). We investigated incident coronary revascularizations, myocardial infarction (MI), stroke, heart failure (HF), unstable angina, and cardiovascular death, in subjects randomized to receive EPA or EPA + docosahexaenoic acid (EPA + DHA) vs. control.
Methods and Results: Meta-analysis of randomized controlled trials (RCTs) was conducted after MEDLINE, Embase, Scopus, Web of Science, and Cochrane Library search. Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines were followed for abstracting data and assessing data quality and validity. Data were pooled using a random effects model. Eighteen RCTs with 134 144 participants (primary and secondary cardiovascular prevention) receiving DHA + EPA (n = 52 498), EPA alone (n = 14 640), or control/placebo (n = 67 006) were included. Follow-up ranged from 4.5 months to 7.4 years. Overall, compared with controls, omega-3 supplementation reduced the risk of revascularization [0.90, 95% confidence interval (CI) 0.84-0.98; P = 0.001; P-heterogeneity = 0.0002; I2 = 68%], MI (0.89, 95% CI 0.81-0.98; P = 0.02; P-heterogeneity = 0.06; I2 = 41%), and cardiovascular death (0.92, 95% CI 0.85-0.99; P = 0.02; P-heterogeneity = 0.13; I2 = 33%). Lower risk was still observed in trials where most participants (≥60%) were on statin therapy. Compared with DHA + EPA, EPA alone showed a further significant risk reduction of revascularizations (0.76, 95% CI 0.65-0.88; P = 0.0002; P-interaction = 0.005) and all outcomes except HF.
Conclusion: Omega-3 fatty acid supplementation reduced the risk of cardiovascular events and coronary revascularization, regardless of background statin use. Eicosapentaenoic acid alone produced greater benefits. The role of specific omega-3 molecules in primary vs. secondary prevention and the potential benefits of reduced revascularizations on overall health status and cost savings warrant further research.
Competing Interests: Conflict of interest: The Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy, and the Center for Clinical and Translational Research—CERICLET, University of Perugia School of Medicine, Perugia, Italy, received an unconditioned research grant from Amarin, not shared with the authors.
(© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.)
Methods and Results: Meta-analysis of randomized controlled trials (RCTs) was conducted after MEDLINE, Embase, Scopus, Web of Science, and Cochrane Library search. Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines were followed for abstracting data and assessing data quality and validity. Data were pooled using a random effects model. Eighteen RCTs with 134 144 participants (primary and secondary cardiovascular prevention) receiving DHA + EPA (n = 52 498), EPA alone (n = 14 640), or control/placebo (n = 67 006) were included. Follow-up ranged from 4.5 months to 7.4 years. Overall, compared with controls, omega-3 supplementation reduced the risk of revascularization [0.90, 95% confidence interval (CI) 0.84-0.98; P = 0.001; P-heterogeneity = 0.0002; I2 = 68%], MI (0.89, 95% CI 0.81-0.98; P = 0.02; P-heterogeneity = 0.06; I2 = 41%), and cardiovascular death (0.92, 95% CI 0.85-0.99; P = 0.02; P-heterogeneity = 0.13; I2 = 33%). Lower risk was still observed in trials where most participants (≥60%) were on statin therapy. Compared with DHA + EPA, EPA alone showed a further significant risk reduction of revascularizations (0.76, 95% CI 0.65-0.88; P = 0.0002; P-interaction = 0.005) and all outcomes except HF.
Conclusion: Omega-3 fatty acid supplementation reduced the risk of cardiovascular events and coronary revascularization, regardless of background statin use. Eicosapentaenoic acid alone produced greater benefits. The role of specific omega-3 molecules in primary vs. secondary prevention and the potential benefits of reduced revascularizations on overall health status and cost savings warrant further research.
Competing Interests: Conflict of interest: The Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy, and the Center for Clinical and Translational Research—CERICLET, University of Perugia School of Medicine, Perugia, Italy, received an unconditioned research grant from Amarin, not shared with the authors.
(© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.)