A Meta-Analysis of Randomized Controlled Trials and Prospective Cohort Studies of Eicosapentaenoic and Docosahexaenoic Long-Chain Omega-3 Fatty Acids and Coronary Heart Disease Risk

Mayo Clinic Proceedings

Volumn 92, Issue 1, 2017, Pages 15-29

  Alexander, Dominik D ^a   Miller, Paige E ^b   Van Elswyk, Mary E ^c   Kuratko, Connye N ^d   Bylsma, Lauren C ^a  

^a EpidStat Institute   (United States)

^b HINES VA HOSPITAL   (United States)

^c Van Elswyk Consulting Inc   (United States)

^d Scientific Affairs   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

DOCOSAHEXAENOIC ACID; ICOSAPENTAENOIC ACID; LOW DENSITY LIPOPROTEIN CHOLESTEROL; OMEGA 3 FATTY ACID; TRIACYLGLYCEROL;

ANGINA PECTORIS; ARTICLE; CARDIOVASCULAR RISK; COHORT ANALYSIS; DIET SUPPLEMENTATION; FOOD COMPOSITION; HEART DEATH; HEART INFARCTION; HIGH RISK PATIENT; HUMAN; HYPERTRIGLYCERIDEMIA; ISCHEMIC HEART DISEASE; META ANALYSIS; PROSPECTIVE STUDY; RANDOMIZED CONTROLLED TRIAL (TOPIC); RISK ASSESSMENT; RISK REDUCTION; STATISTICAL SIGNIFICANCE; SUDDEN CARDIAC DEATH; SYSTEMATIC REVIEW; CORONARY DISEASE; PROPORTIONAL HAZARDS MODEL;

CORONARY DISEASE; DOCOSAHEXAENOIC ACIDS; EICOSAPENTAENOIC ACID; HUMANS; PROPORTIONAL HAZARDS MODELS; PROSPECTIVE STUDIES; RANDOMIZED CONTROLLED TRIALS AS TOPIC; RISK ASSESSMENT;

EID: 85009141814     PISSN: 00256196     EISSN: 19425546     Source Type: Journal    
DOI: 10.1016/j.mayocp.2016.10.018     Document Type: Article

References (74)

1. 1 Eckel, R.H., Jakicic, J.M., Ard, J.D., et al. 2014 AHA/ACC guideline on lifestyle management to reduce cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 63:25 Pt B (2014), 2960–2984.
2. 2 Fats and fatty acids in human nutrition: report of an expert consultation. FAO Food Nutr Pap 91 (2010), 1–166.
3. 3 Moher, D., Liberati, A., Tetzlaff, J., Altman, D.G., Prisma Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. J Clin Epidemiol 62:10 (2009), 1006–1012.
4. 4 Trikalinos, T.A., Lee, J., Moorthy, D., et al. Effects of eicosapentanoic acid and docosahexanoic acid on mortality across diverse settings: systematic review and meta-analysis of randomized trials and prospective cohorts. AHRQ Tech Rev, 4, 2012 12-EHC040-EF.
5. 5 Delgado-Lista, J., Perez-Martinez, P., Lopez-Miranda, J., Perez-Jimenez, F., Long chain omega-3 fatty acids and cardiovascular disease: a systematic review. Br J Nutr 107:Suppl 2 (2012), S201–S213.
6. 6 Kotwal, S., Jun, M., Sullivan, D., Perkovic, V., Neal, B., Omega 3 fatty acids and cardiovascular outcomes: systematic review and meta-analysis. Circ Cardiovasc Qual Outcomes 5:6 (2012), 808–818.
7. 7 Kwak, S.M., Myung, S.K., Lee, Y.J., Seo, H.G., Korean Meta-analysis Study Group. Efficacy of omega-3 fatty acid supplements (eicosapentaenoic acid and docosahexaenoic acid) in the secondary prevention of cardiovascular disease: a meta-analysis of randomized, double-blind, placebo-controlled trials. Arch Intern Med 172:9 (2012), 686–694.
8. 8 Rizos, E.C., Ntzani, E.E., Bika, E., Kostapanos, M.S., Elisaf, M.S., Association between omega-3 fatty acid supplementation and risk of major cardiovascular disease events: a systematic review and meta-analysis. JAMA 308:10 (2012), 1024–1033.
9. 9 Chen, Q., Cheng, L.Q., Xiao, T.H., et al. Effects of omega-3 fatty acid for sudden cardiac death prevention in patients with cardiovascular disease: a contemporary meta-analysis of randomized, controlled trials. Cardiovasc Drugs Ther 25:3 (2011), 259–265.
10. 10 Filion, K.B., El Khoury, F., Bielinski, M., Schiller, I., Dendukuri, N., Brophy, J.M., Omega-3 fatty acids in high-risk cardiovascular patients: a meta-analysis of randomized controlled trials. BMC Cardiovasc Disord, 10, 2010, 24.
11. 11 DerSimonian, R., Laird, N., Meta-analysis in clinical trials. Control Clin Trials 7:3 (1986), 177–188.
12. 12 Rothstein, H.R., Sutton, A.J., Borenstein, M., Publication Bias in Meta-Analysis—Prevention, Assessment and Adjustments. 2005, John Wiley & Sons, Ltd, West Sussex, England, UK.
13. 13 Brouwer, I.A., Zock, P.L., Camm, A.J., et al. Effect of fish oil on ventricular tachyarrhythmia and death in patients with implantable cardioverter defibrillators: the Study on Omega-3 Fatty Acids and Ventricular Arrhythmia (SOFA) randomized trial. JAMA 295:22 (2006), 2613–2619.
14. 14 Burr, M.L., Fehily, A.M., Gilbert, J.F., et al. Effects of changes in fat, fish, and fibre intakes on death and myocardial reinfarction: diet and reinfarction trial (DART). Lancet 2:8666 (1989), 757–761.
15. 15 Burr, M.L., Ashfield-Watt, P.A., Dunstan, F.D., et al. Lack of benefit of dietary advice to men with angina: results of a controlled trial. Eur J Clin Nutr 57:2 (2003), 193–200.
16. 16 Einvik, G., Klemsdal, T.O., Sandvik, L., Hjerkinn, E.M., A randomized clinical trial on n-3 polyunsaturated fatty acids supplementation and all-cause mortality in elderly men at high cardiovascular risk. Eur J Cardiovasc Prev Rehabil 17:5 (2010), 588–592.
17. 17 Galan, P., Kesse-Guyot, E., Czernichow, S., et al., SU.FOL.OM3 Collaborative Group. Effects of B vitamins and omega 3 fatty acids on cardiovascular diseases: a randomised placebo controlled trial. BMJ, 341, 2010, c6273.
18. 18 Ishikawa, Y., Yokoyama, M., Saito, Y., et al., JELIS Investigators. Preventive effects of eicosapentaenoic acid on coronary artery disease in patients with peripheral artery disease. Circ J 74:7 (2010), 1451–1457.
19. 19 Johansen, O., Brekke, M., Seljeflot, I., Abdelnoor, M., Arnesen, H., N-3 fatty acids do not prevent restenosis after coronary angioplasty: results from the CART study. Coronary Angioplasty Restenosis Trial. J Am Coll Cardiol 33:6 (1999), 1619–1626.
20. 20 Kromhout, D., Giltay, E.J., Geleijnse, J.M., Alpha Omega Trial Group. n-3 fatty acids and cardiovascular events after myocardial infarction. N Engl J Med 363:21 (2010), 2015–2026.
21. 21 Kromhout, D., Geleijnse, J.M., de Goede, J., et al. n-3 fatty acids, ventricular arrhythmia-related events, and fatal myocardial infarction in postmyocardial infarction patients with diabetes. Diabetes Care 34:12 (2011), 2515–2520.
22. 22 Leaf, A., Albert, C.M., Josephson, M., et al., Fatty Acid Antiarrhythmia Trial Investigators. Prevention of fatal arrhythmias in high-risk subjects by fish oil n-3 fatty acid intake. Circulation 112:18 (2005), 2762–2768.
23. 23 Macchia, A., Levantesi, G., Franzosi, M.G., et al., GISSI-Prevenzione Investigators. Left ventricular systolic dysfunction, total mortality, and sudden death in patients with myocardial infarction treated with n-3 polyunsaturated fatty acids. Eur J Heart Fail 7:5 (2005), 904–909.
24. 24 Macchia, A., Grancelli, H., Varini, S., et al., GESICA Investigators. Omega-3 fatty acids for the prevention of recurrent symptomatic atrial fibrillation: results of the FORWARD (Randomized Trial to Assess Efficacy of PUFA for the Maintenance of Sinus Rhythm in Persistent Atrial Fibrillation) trial. J Am Coll Cardiol 61:4 (2013), 463–468.
25. 25 Marchioli, R., Schweiger, C., Tavazzi, L., Valagussa, F., Efficacy of n-3 polyunsaturated fatty acids after myocardial infarction: results of GISSI-Prevenzione trial. Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico. Lipids 36:Suppl (2001), S119–S126.
26. 26 Raitt, M.H., Connor, W.E., Morris, C., et al. Fish oil supplementation and risk of ventricular tachycardia and ventricular fibrillation in patients with implantable defibrillators: a randomized controlled trial. JAMA 293:23 (2005), 2884–2891.
27. 27 Rauch, B., Schiele, R., Schneider, S., et al., OMEGA Study Group. OMEGA, a randomized, placebo-controlled trial to test the effect of highly purified omega-3 fatty acids on top of modern guideline-adjusted therapy after myocardial infarction. Circulation 122:21 (2010), 2152–2159.
28. 28 Roncaglioni, M.C., Tombesi, M., Silletta, M.G., n-3 fatty acids in patients with cardiac risk factors. N Engl J Med 369:8 (2013), 781–782.
29. 29 Singh, R.B., Niaz, M.A., Sharma, J.P., Kumar, R., Rastogi, V., Moshiri, M., Randomized, double-blind, placebo-controlled trial of fish oil and mustard oil in patients with suspected acute myocardial infarction: the Indian experiment of infarct survival–4. Cardiovasc Drugs Ther 11:3 (1997), 485–491.
30. 30 von Schacky, C., Angerer, P., Kothny, W., Theisen, K., Mudra, H., The effect of dietary omega-3 fatty acids on coronary atherosclerosis: a randomized, double-blind, placebo-controlled trial. Ann Intern Med 130:7 (1999), 554–562.
31. 31 Yokoyama, M., Origasa, H., Matsuzaki, M., et al., Japan EPA lipid intervention study (JELIS) Investigators. Effects of eicosapentaenoic acid on major coronary events in hypercholesterolaemic patients (JELIS): a randomised open-label, blinded endpoint analysis. Lancet 369:9567 (2007), 1090–1098.
32. 32 ORIGIN Trial Investigators, Bosch, J., Gerstein, H.C., Dagenais, G.R., et al. n-3 fatty acids and cardiovascular outcomes in patients with dysglycemia. N Engl J Med 367:4 (2012), 309–318.
33. 33 Nilsen, D.W., Albrektsen, G., Landmark, K., Moen, S., Aarsland, T., Woie, L., Effects of a high-dose concentrate of n-3 fatty acids or corn oil introduced early after an acute myocardial infarction on serum triacylglycerol and HDL cholesterol. Am J Clin Nutr 74:1 (2001), 50–56.
34. 34 Albert, C.M., Hennekens, C.H., O'Donnell, C.J., et al. Fish consumption and risk of sudden cardiac death. JAMA 279:1 (1998), 23–28.
35. 35 Amiano, P., Machon, M., Dorronsoro, M., et al. Intake of total omega-3 fatty acids, eicosapentaenoic acid and docosahexaenoic acid and risk of coronary heart disease in the Spanish EPIC cohort study. Nutr Metab Cardiovasc Dis 24:3 (2014), 321–327.
36. 36 Bergkvist, C., Berglund, M., Glynn, A., Wolk, A., Akesson, A., Dietary exposure to polychlorinated biphenyls and risk of myocardial infarction—a population-based prospective cohort study. Int J Cardiol 183 (2015), 242–248.
37. 37 Ascherio, A., Rimm, E.B., Stampfer, M.J., Giovannucci, E.L., Willett, W.C., Dietary intake of marine n-3 fatty acids, fish intake, and the risk of coronary disease among men. N Engl J Med 332:15 (1995), 977–982.
38. 38 Chiuve, S.E., Rimm, E.B., Sandhu, R.K., et al. Dietary fat quality and risk of sudden cardiac death in women. Am J Clin Nutr 96:3 (2012), 498–507.
39. 39 de Goede, J., Geleijnse, J.M., Boer, J.M., Kromhout, D., Verschuren, W.M., Marine (n-3) fatty acids, fish consumption, and the 10-year risk of fatal and nonfatal coronary heart disease in a large population of Dutch adults with low fish intake. J Nutr 140:5 (2010), 1023–1028.
40. 40 Hu, F.B., Cho, E., Rexrode, K.M., Albert, C.M., Manson, J.E., Fish and long-chain omega-3 fatty acid intake and risk of coronary heart disease and total mortality in diabetic women. Circulation 107:14 (2003), 1852–1857.
41. 41 Iso, H., Kobayashi, M., Ishihara, J., et al., JPHC Study Group. Intake of fish and n3 fatty acids and risk of coronary heart disease among Japanese: the Japan Public Health Center-Based (JPHC) Study Cohort I. Circulation 113:2 (2006), 195–202.
42. 42 Koh, A.S., Pan, A., Wang, R., et al. The association between dietary omega-3 fatty acids and cardiovascular death: the Singapore Chinese Health Study. Eur J Prev Cardiol 22:3 (2015), 364–372.
43. 43 Jarvinen, R., Knekt, P., Rissanen, H., Reunanen, A., Intake of fish and long-chain n-3 fatty acids and the risk of coronary heart mortality in men and women. Br J Nutr 95:4 (2006), 824–829.
44. 44 Joensen, A.M., Schmidt, E.B., Dethlefsen, C., et al. Dietary intake of total marine n-3 polyunsaturated fatty acids, eicosapentaenoic acid, docosahexaenoic acid and docosapentaenoic acid and the risk of acute coronary syndrome—a cohort study. Br J Nutr 103:4 (2010), 602–607.
45. 45 Manger, M.S., Strand, E., Ebbing, M., et al. Dietary intake of n-3 long-chain polyunsaturated fatty acids and coronary events in Norwegian patients with coronary artery disease. Am J Clin Nutr 92:1 (2010), 244–251.
46. 46 Mozaffarian, D., Ascherio, A., Hu, F.B., et al. Interplay between different polyunsaturated fatty acids and risk of coronary heart disease in men. Circulation 111:2 (2005), 157–164.
47. 47 Pietinen, P., Ascherio, A., Korhonen, P., et al. Intake of fatty acids and risk of coronary heart disease in a cohort of Finnish men. The Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study. Am J Epidemiol 145:10 (1997), 876–887.
48. 48 Streppel, M.T., Ocke, M.C., Boshuizen, H.C., Kok, F.J., Kromhout, D., Long-term fish consumption and n-3 fatty acid intake in relation to (sudden) coronary heart disease death: the Zutphen study. Eur Heart J 29:16 (2008), 2024–2030.
49. 49 Yuan, J.M., Ross, R.K., Gao, Y.T., Yu, M.C., Fish and shellfish consumption in relation to death from myocardial infarction among men in Shanghai, China. Am J Epidemiol 154:9 (2001), 809–816.
50. 50 Takata, Y., Zhang, X., Li, H., et al. Fish intake and risks of total and cause-specific mortality in 2 population-based cohort studies of 134,296 men and women. Am J Epidemiol 178:1 (2013), 46–57.
51. 51 Miyagawa, N., Miura, K., Okuda, N., et al., NIPPON DATA80 Research Group. Long-chain n-3 polyunsaturated fatty acids intake and cardiovascular disease mortality risk in Japanese: a 24-year follow-up of NIPPON DATA80. Atherosclerosis 232:2 (2014), 384–389.
52. 52 Bernstein, A.M., Ding, E.L., Willett, W.C., Rimm, E.B., A meta-analysis shows that docosahexaenoic acid from algal oil reduces serum triglycerides and increases HDL-cholesterol and LDL-cholesterol in persons without coronary heart disease. J Nutr 142:1 (2012), 99–104.
53. 53 Nordestgaard, B.G., Varbo, A., Triglycerides and cardiovascular disease. Lancet 384:9943 (2014), 626–635.
54. 54 Wei, M.Y., Jacobson, T.A., Effects of eicosapentaenoic acid versus docosahexaenoic acid on serum lipids: a systematic review and meta-analysis. Curr Atheroscler Rep 13:6 (2011), 474–483.
55. 55 Mori, T.A., Burke, V., Puddey, I.B., et al. Purified eicosapentaenoic and docosahexaenoic acids have differential effects on serum lipids and lipoproteins, LDL particle size, glucose, and insulin in mildly hyperlipidemic men. Am J Clin Nutr 71:5 (2000), 1085–1094.
56. 56 Maki, K.C., McKenney, J.M., Reeves, M.S., Lubin, B.C., Dicklin, M.R., Effects of adding prescription omega-3 acid ethyl esters to simvastatin (20 mg/day) on lipids and lipoprotein particles in men and women with mixed dyslipidemia. Am J Cardiol 102:4 (2008), 429–433.
57. 57 Carroll, M., Kit, B., Lacher, D., Trends in elevated triglyceride in adults: United States, 2001-2012. NCHS Data Brief(198), 2015, 198.
58. 58 Kuklina, E.V., Carroll, M.D., Shaw, K.M., Hirsch, R., Trends in high LDL cholesterol, cholesterol-lowering medication use, and dietary saturated-fat intake: United States, 1976-2010. NCHS Data Brief(117), 2013, 1–8.
59. 59 Miller, P.E., Van Elswyk, M., Alexander, D.D., Long-chain omega-3 fatty acids eicosapentaenoic acid and docosahexaenoic acid and blood pressure: a meta-analysis of randomized controlled trials. Am J Hypertens 27:7 (2014), 885–896.
60. 60 Wen, Y.T., Dai, J.H., Gao, Q., Effects of Omega-3 fatty acid on major cardiovascular events and mortality in patients with coronary heart disease: a meta-analysis of randomized controlled trials. Nutr Metab Cardiovasc Dis 24:5 (2014), 470–475.
61. 61 Casula, M., Soranna, D., Catapano, A.L., Corrao, G., Long-term effect of high dose omega-3 fatty acid supplementation for secondary prevention of cardiovascular outcomes: a meta-analysis of randomized, placebo controlled trials [corrected]. Atheroscler Suppl 14:2 (2013), 243–251.
62. 62 Wang, C., Harris, W.S., Chung, M., et al. n-3 Fatty acids from fish or fish-oil supplements, but not alpha-linolenic acid, benefit cardiovascular disease outcomes in primary- and secondary-prevention studies: a systematic review. Am J Clin Nutr 84:1 (2006), 5–17.
63. 63 Chowdhury, R., Warnakula, S., Kunutsor, S., et al. Association of dietary, circulating, and supplement fatty acids with coronary risk: a systematic review and meta-analysis. Ann Intern Med 160:6 (2014), 398–406.
64. 64 Zheng, J., Huang, T., Yu, Y., Hu, X., Yang, B., Li, D., Fish consumption and CHD mortality: an updated meta-analysis of seventeen cohort studies. Public Health Nutr 15:4 (2012), 725–737.
65. 65 Saravanan, P., Davidson, N.C., Schmidt, E.B., Calder, P.C., Cardiovascular effects of marine omega-3 fatty acids. Lancet 376:9740 (2010), 540–550.
66. 66 Mozaffarian, D., Rimm, E.B., Fish intake, contaminants, and human health: evaluating the risks and the benefits. JAMA 296:15 (2006), 1885–1899.
67. 67 Mozaffarian, D., Fish and n-3 fatty acids for the prevention of fatal coronary heart disease and sudden cardiac death. Am J Clin Nutr 87:6 (2008), 1991S–1996S.
68. 68 Mozaffarian, D., Wu, J.H., Omega-3 fatty acids and cardiovascular disease: effects on risk factors, molecular pathways, and clinical events. J Am Coll Cardiol 58:20 (2011), 2047–2067.
69. 69 Murray, C.J., Atkinson, C., Bhalla, K., et al., U.S. Burden of Disease Collaborators. The state of U.S. health, 1990-2010: burden of diseases, injuries, and risk factors. JAMA 310:6 (2013), 591–608.
70. 70 GBD 2013 Mortality and Causes of Death Collaborators. Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 385:9963 (2015), 117–171.
71. 71 Lim, S.S., Vos, T., Flaxman, A.D., et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 380:9859 (2012), 2224–2260 Erratum in Lancet. 2013;381(9867):628. AlMazroa, Mohammad A [added]; Memish, Ziad A [added]. Lancet. 2013;381(9874):1276.
72. 72 Danaei, G., Ding, E.L., Mozaffarian, D., et al. The preventable causes of death in the United States: comparative risk assessment of dietary, lifestyle, and metabolic risk factors. PLoS Med, 6(4), 2009, e1000058.
73. 73 EFSA Panel on Dietetic Products, Nutrition, Allergies. Scientific Opinion on Dietary Reference Values for fats, including saturated fatty acids, polyunsaturated fatty acids, monounsaturated fatty acids, trans fatty acids, and cholesterol. EFSA J 8:3 (2010), 1461–1568.
74. 74 National Health and Medical Research Council. Nutrient reference values for Australia and New Zealand including recommended dietary intakes. 2006 https://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/n35.pdf Accessed March 14, 2016.