Omega-3 Polyunsaturated Fatty Acid (Fish Oil) Supplementation and the Prevention of Clinical Cardiovascular Disease: A Science Advisory from the American Heart Association

Circulation

Volumn 135, Issue 15, 2017, Pages e867-e884

  Siscovick, David S ^a   Barringer, Thomas A ^a   Fretts, Amanda M ^a   Wu, Jason H Y ^a   Lichtenstein, Alice H ^a   Costello, Rebecca B ^a   Kris Etherton, Penny M ^a   Jacobson, Terry A ^a   Engler, Mary B ^a   Alger, Heather M ^a   Appel, Lawrence J ^a   Mozaffarian, Dariush ^a  

^a NONE

Author keywords

AHA Scientific Statements; cardiovascular disease; fatty acids, omega 3; fish oils; prevention and control; randomized controlled trials

Indexed keywords

OMEGA 3 FATTY ACID; FISH OIL;

ARTICLE; ATRIAL FIBRILLATION; CARDIOVASCULAR DISEASE; CARDIOVASCULAR MORTALITY; CARDIOVASCULAR RISK; CEREBROVASCULAR ACCIDENT; DIABETES MELLITUS; DIET SUPPLEMENTATION; EVIDENCE BASED MEDICINE; HEART FAILURE; HEART SURGERY; HIGH RISK POPULATION; HUMAN; IMPAIRED GLUCOSE TOLERANCE; MEDICAL SOCIETY; META ANALYSIS (TOPIC); PRIMARY PREVENTION; PRIORITY JOURNAL; RANDOMIZED CONTROLLED TRIAL (TOPIC); SECONDARY PREVENTION; SYSTEMATIC REVIEW; ADVERSE EFFECTS; CARDIOVASCULAR DISEASES; DIABETIC COMPLICATION; DIETARY SUPPLEMENT; MORTALITY; RISK; STROKE;

ATRIAL FIBRILLATION; CARDIAC SURGICAL PROCEDURES; CARDIOVASCULAR DISEASES; DIABETES COMPLICATIONS; DIABETES MELLITUS; DIETARY SUPPLEMENTS; FATTY ACIDS, OMEGA-3; FISH OILS; HEART FAILURE; HUMANS; PRIMARY PREVENTION; RISK; SECONDARY PREVENTION; STROKE;

EID: 85015204246     PISSN: 00097322     EISSN: 15244539     Source Type: Journal    
DOI: 10.1161/CIR.0000000000000482     Document Type: Article

References (53)

1. Kris-Etherton PM, Harris WS, Appel LJ; for the American Heart Association, Nutrition Committee. Fish consumption, fish oil, omega-3 fatty acids, and cardiovascular disease [published correction appears in Circulation. 2003;107:512]. Circulation. 2002;106:2747-2757.
2. Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto miocardico. Dietary supplementation with n-3 polyunsaturated fatty acids and vitamin E after myocardial infarction: results of the GISSI-Prevenzione trial: Gruppo Italiano per lo Studio Della Sopravvivenza nell'Infarto miocardico [published corrections appear in Lancet. 2001;357:642 and Lancet. 2007;369:106]. Lancet. 1999;354:447-455.
3. Burr ML, Fehily AM, Gilbert JF, Rogers S, Holliday RM, Sweetnam PM, Elwood PC, Deadman NM. Effects of changes in fat, fish, and fibre intakes on death and myocardial reinfarction: Diet and Reinfarction Trial (DART). Lancet. 1989;2:757-761.
4. ORIGIN Trial Investigators, Bosch J, Gerstein HC, Dagenais GR, Diaz R, Dyal L, Jung H, Maggiono AP, Probstfield J, Ramachandran A, Riddle MC, Ryden LE, Yusuf S. n-3 Fatty acids and cardiovascular outcomes in patients with dysglycemia. N Engl J Med. 2012;367:309-318. doi: 10.1056/NEJMoa1203859.
5. Yokoyama M, Origasa H, Matsuzaki M, Matsuzawa Y, Saito Y, Ishikawa Y, Oikawa S, Sasaki J, Hishida H, Itakura H, Kita T, Kitabatake A, Nakaya N, Sakata T, Shimada K, Shirato K; 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 [published correction appears in Lancet. 2007;370:220]. Lancet. 2007;369:1090-1098. doi: 10.1016/ S0140-6736(07)60527-3.
6. Risk and Prevention Study Collaborative Group. n-3 Fatty acids in patients with multiple cardiovascular risk factors [published correction appears in N Engl J Med. 2013;368:2146]. N Engl J Med. 2013;368:1800-1808. doi: 10.1056/NEJMoa1205409.
7. Writing Group for the AREDS2 Research Group,Bonds DE, Harrington M, Worrall BB, Bertoni AG, Eaton CB, Hsia J, Robinson J, Clemons TE, Fine LJ, Chew EY. Effect of long-chain ω-3 fatty acids and lutein+zeaxanthin supplements on cardiovascular outcomes: results of the Age-Related Eye Disease Study 2 (AREDS2) randomized clinical trial. JAMA Intern Med. 2014;174:763-771. doi: 10.1001/jamainternmed.2014.328.
8. Rauch B, Schiele R, Schneider S, Diller F, Victor N, Gohlke H, Gottwik M, Steinbeck G, Del Castillo U, Sack R, Worth H, Katus H, Spitzer W, Sabin G, Senges J; 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. 2010;122:2152-2159. doi: 10.1161/CIRCULATIONAHA.110.948562.
9. Kromhout D, Giltay EJ, Geleijnse JM; Alpha Omega Trial Group. n-3 Fatty acids and cardiovascular events after myocardial infarction. N Engl J Med. 2010;363:2015-2026. doi: 10.1056/ NEJMoa1003603.
10. Galan P, Kesse-Guyot E, Czernichow S, Briancon S, Blacher J, Hercberg S; SU.FOL.OM3 Collaborative Group. Effects of B vitamins and omega 3 fatty acids on cardiovascular diseases: a randomised placebo controlled trial. BMJ. 2010;341:c6273. doi: 10.1136/bmj.c6273.
11. Rizos EC, Ntzani EE, Bika E, Kostapanos MS, Elisaf MS. Association between omega-3 fatty acid supplementation and risk of major cardiovascular disease events: a systematic review and metaanalysis. JAMA. 2012;308:1024-1033. doi: 10.1001/2012. jama.11374.
12. Tavazzi L, Maggioni AP, Marchioli R, Barlera S, Franzosi MG, Latini R, Lucci D, Nicolosi GL, Porcu M, Tognoni G; Gissi-HF Investigators. Effect of n-3 polyunsaturated fatty acids in patients with chronic heart failure (the GISSI-HF trial): a randomised, doubleblind, placebo-controlled trial. Lancet. 2008;372:1223-1230. doi: 10.1016/S0140-6736(08)61239-8.
13. Kowey PR, Reiffel JA, Ellenbogen KA, Naccarelli GV, Pratt CM. Efficacy and safety of prescription omega-3 fatty acids for the prevention of recurrent symptomatic atrial fibrillation: a randomized controlled trial. JAMA. 2010;304:2363-2372. doi: 10.1001/ jama.2010.1735.
14. Macchia A, Grancelli H, Varini S, Nul D, Laffaye N, Mariani J, Ferrante D, Badra R, Figal J, Ramos S, Tognoni G, Doval HC; 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. 2013;61:463-468. doi: 10.1016/j.jacc.2012.11.021.
15. Mariani J, Doval HC, Nul D, Varini S, Grancelli H, Ferrante D, Tognoni G, Macchia A. N-3 polyunsaturated fatty acids to prevent atrial fibrillation: updated systematic review and meta-analysis of randomized controlled trials. J Am Heart Assoc. 2013;2:e005033. doi: 10.1161/JAHA.112.005033.
16. Mozaffarian D, Marchioli R, Macchia A, Silletta MG, Ferrazzi P, Gardner TJ, Latini R, Libby P, Lombardi F, O'Gara PT, Page RL, Tavazzi L, Tognoni G; OPERA Investigators. Fish oil and postoperative atrial fibrillation: the Omega-3 Fatty Acids for Prevention of Post-operative Atrial Fibrillation (OPERA) randomized trial [published correction appears in JAMA. 2013;309:876]. JAMA. 2012;308:2001-2011. doi: 10.1001/jama.2012.28733.
17. Mozaffarian D, Wu JH, de Oliveira Otto MC, Sandesara CM, Metcalf RG, Latini R, Libby P, Lombardi F, O'Gara PT, Page RL, Silletta MG, Tavazzi L, Marchioli R. Fish oil and post-operative atrial fibrillation: a meta-analysis of randomized controlled trials. J Am Coll Cardiol. 2013;61:2194-2196. doi: 10.1016/j. jacc.2013.02.045.
18. Clarke TC, Black LI, Stussman BJ, Barnes PM, Nahin RL. Trends in the use of complementary health approaches among adults: United States, 2002-2012. Natl Health Stat Report. 2015:1-16
19. National Institutes of Health and National Library of Medicine. National Library of Medicine dietary supplement label database. https://dsld.nlm.nih.gov/dsld/. Accessed January 11, 2017.
20. US Department of Agriculture. US Department of Agriculture dietary supplement ingredient database release 3.0. https://dietary supplementdatabase.usda.nih.gov/. Accessed January 11, 2017.
21. US Pharmacopeial Convention. USP verified mark. http://www. usp.org/verification-services/usp-verified-mark. Accessed January 11, 2017.
22. US National Library of Medicine. Omega-3 fatty acids. https:// www.nlm.nih.gov/medlineplus/druginfo/meds/a607065.html. Accessed January 11, 2017.
23. Schuchardt JP, Schneider I, Meyer H, Neubronner J, von Schacky C, Hahn A. Incorporation of EPA and DHA into plasma phospholipids in response to different omega-3 fatty acid formulations: a comparative bioavailability study of fish oil vs. krill oil. Lipids Health Dis. 2011;10:145. doi: 10.1186/1476-511X-10-145.
24. Offman E, Marenco T, Ferber S, Johnson J, Kling D, Curcio D, Davidson M. Steady-state bioavailability of prescription omega-3 on a low-fat diet is significantly improved with a free fatty acid formulation compared with an ethyl ester formulation: the ECLIPSE II study. Vasc Health Risk Manag. 2013;9:563-573. doi: 10.2147/ VHRM.S50464.
25. Davidson MH, Johnson J, Rooney MW, Kyle ML, Kling DF. A novel omega-3 free fatty acid formulation has dramatically improved bioavailability during a low-fat diet compared with omega-3-acid ethyl esters: the ECLIPSE (Epanova(® ) compared to Lovaza(® ) in a pharmacokinetic single-dose evaluation) study. J Clin Lipidol. 2012;6:573-584. doi: 10.1016/j.jacl.2012.01.002.
26. Dyerberg J, Madsen P, Møller JM, Aardestrup I, Schmidt EB. Bioavailability of marine n-3 fatty acid formulations. Prostaglandins Leukot Essent Fatty Acids. 2010;83:137-141. doi: 10.1016/j. plefa.2010.06.007.
27. Oikawa S, Yokoyama M, Origasa H, Matsuzaki M, Matsuzawa Y, Saito Y, Ishikawa Y, Sasaki J, Hishida H, Itakura H, Kita T, Kitabatake A, Nakaya N, Sakata T, Shimada K, Shirato K; JELIS Investigators, Japan. Suppressive effect of EPA on the incidence of coronary events in hypercholesterolemia with impaired glucose metabolism: sub-analysis of the Japan EPA Lipid Intervention Study (JELIS). Atherosclerosis. 2009;206:535-539. doi: 10.1016/j.atherosclerosis.2009.03.029.
28. Kromhout D, Geleijnse JM, de Goede J, Oude Griep LM, Mulder BJ, de Boer MJ, Deckers JW, Boersma E, Zock PL, Giltay EJ. n-3 Fatty acids, ventricular arrhythmia-related events, and fatal myocardial infarction in postmyocardial infarction patients with diabetes. Diabetes Care. 2011;34:2515-2520. doi: 10.2337/dc11-0896.
29. British Heart Foundation. ASCEND: A Study of Cardiovascular Events in Diabetes. https://ascend.medsci.ox.ac.uk/. Accessed January 11, 2017.
30. Burr ML, Ashfield-Watt PA, Dunstan FD, Fehily AM, Breay P, Ashton T, Zotos PC, Haboubi NA, Elwood PC. Lack of benefit of dietary advice to men with angina: results of a controlled trial. Eur J Clin Nutr. 2003;57:193-200. doi: 10.1038/sj.ejcn.1601539.
31. Chowdhury R, Stevens S, Gorman D, Pan A, Warnakula S, Chowdhury S, Ward H, Johnson L, Crowe F, Hu FB, Franco OH. Association between fish consumption, long chain omega 3 fatty acids, and risk of cerebrovascular disease: systematic review and metaanalysis. BMJ. 2012;345:e6698. doi: 10.1136/bmj.e6698.
32. Kwak SM, Myung SK, Lee YJ, Seo HG; 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, doubleblind, placebo-controlled trials. Arch Intern Med. 2012;172:686-694. doi: 10.1001/archinternmed.2012.262.
33. Kotwal S, Jun M, Sullivan D, Perkovic V, Neal B. Omega 3 fatty acids and cardiovascular outcomes: systematic review and metaanalysis. Circ Cardiovasc Qual Outcomes. 2012;5:808-818. doi: 10.1161/CIRCOUTCOMES.112.966168.
34. Tanaka K, Ishikawa Y, Yokoyama M, Origasa H, Matsuzaki M, Saito Y, Matsuzawa Y, Sasaki J, Oikawa S, Hishida H, Itakura H, Kita T, Kitabatake A, Nakaya N, Sakata T, Shimada K, Shirato K; JELIS Investigators, Japan. Reduction in the recurrence of stroke by eicosapentaenoic acid for hypercholesterolemic patients: subanalysis of the JELIS trial [published correction appears in Stroke. 2008;39:e149]. Stroke. 2008;39:2052-2058. doi: 10.1161/ STROKEAHA.107.509455.
35. Wu JH, Lemaitre RN, King IB, Song X, Sacks FM, Rimm EB, Heckbert SR, Siscovick DS, Mozaffarian D. Association of plasma phospholipid long-chain ω-3 fatty acids with incident atrial fibrillation in older adults: the Cardiovascular Health Study. Circulation. 2012;125:1084-1093. doi: 10.1161/ CIRCULATIONAHA.111.062653.
36. Nigam A, Talajic M, Roy D, Nattel S, Lambert J, Nozza A, Jones P, Ramprasath VR, O'Hara G, Kopecky S, Brophy JM, Tardif JC; AFFORD Investigators. Fish oil for the reduction of atrial fibrillation recurrence, inflammation, and oxidative stress. J Am Coll Cardiol. 2014;64:1441-1448. doi: 10.1016/j.jacc.2014.07.956.
37. Darghosian L, Free M, Li J, Gebretsadik T, Bian A, Shintani A, Mc-Bride BF, Solus J, Milne G, Crossley GH, Thompson D, Vidaillet H, Okafor H, Darbar D, Murray KT, Stein CM. Effect of omega-three polyunsaturated fatty acids on inflammation, oxidative stress, and recurrence of atrial fibrillation. Am J Cardiol. 2015;115:196-201. doi: 10.1016/j.amjcard.2014.10.022.
38. Farquharson AL, Metcalf RG, Sanders P, Stuklis R, Edwards JR, Gibson RA, Cleland LG, Sullivan TR, James MJ, Young GD. Effect of dietary fish oil on atrial fibrillation after cardiac surgery. Am J Cardiol. 2011;108:851-856. doi: 10.1016/j.amjcard.2011.04.036.
39. Heidarsdottir R, Arnar DO, Skuladottir GV, Torfason B, Edvardsson V, Gottskalksson G, Palsson R, Indridason OS. Does treatment with n-3 polyunsaturated fatty acids prevent atrial fibrillation after open heart surgery? Europace. 2010;12:356-363. doi: 10.1093/europace/eup429.
40. Heidt MC, Vician M, Stracke SK, Stadlbauer T, Grebe MT, Boening A, Vogt PR, Erdogan A. Beneficial effects of intravenously administered N-3 fatty acids for the prevention of atrial fibrillation after coronary artery bypass surgery: a prospective randomized study. Thorac Cardiovasc Surg. 2009;57:276-280. doi: 10.1055/s-0029-1185301.
41. Sandesara CM, Chung MK, Van Wagoner DR, Barringer TA, Allen K, Ismail HM, Zimmerman B, Olshansky B. A randomized, placebocontrolled trial of omega-3 fatty acids for inhibition of supraventricular arrhythmias after cardiac surgery: the FISH Trial. J Am Heart Assoc. 2012;1:e000547. doi: 10.1161/JAHA.111.000547.
42. Saravanan P, Bridgewater B, West AL, O'Neill SC, Calder PC, Davidson NC. Omega-3 fatty acid supplementation does not reduce risk of atrial fibrillation after coronary artery bypass surgery: a randomized, double-blind, placebo-controlled clinical trial. Circ Arrhythm Electrophysiol. 2010;3:46-53. doi: 10.1161/CIRCEP. 109.899633.
43. Mozaffarian D, Wu JH. Omega-3 fatty acids and cardiovascular disease: effects on risk factors, molecular pathways, and clinical events. J Am Coll Cardiol. 2011;58:2047-2067. doi: 10.1016/j. jacc.2011.06.063.
44. Marchioli R, Barzi F, Bomba E, Chieffo C, Di Gregorio D, Di Mascio R, Franzosi MG, Geraci E, Levantesi G, Maggioni AP, Mantini L, Marfisi RM, Mastrogiuseppe G, Mininni N, Nicolosi GL, Santini M, Schweiger C, Tavazzi L, Tognoni G, Tucci C, Valagussa F; GISSIPrevenzione Investigators. Early protection against sudden death by n-3 polyunsaturated fatty acids after myocardial infarction: time-course analysis of the results of the Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico (GISSI)-Prevenzione. Circulation. 2002;105:1897-1903.
45. Jacobson TA, Maki KC, Orringer CE, Jones PH, Kris-Etherton P, Sikand G, La Forge R, Daniels SR, Wilson DP, Morris PB, Wild RA, Grundy SM, Daviglus M, Ferdinand KC, Vijayaraghavan K, Deedwania PC, Aberg JA, Liao KP, McKenney JM, Ross JL, Braun LT, Ito MK, Bays HE, Brown WV, Underberg JA; NLA Expert Panel. National Lipid Association recommendations for patient-centered management of dyslipidemia: part 2 [published correction appears in J Clin Lipidol. 2016;10:211]. J Clin Lipidol. 2015;9(supp l):S1-122.e1. doi: 10.1016/j.jacl.2015.09.002.
46. Miller M, Stone NJ, Ballantyne C, Bittner V, Criqui MH, Ginsberg HN, Goldberg AC, Howard WJ, Jacobson MS, Kris-Etherton PM, Lennie TA, Levi M, Mazzone T, Pennathur S; on behalf of the American Heart Association Clinical Lipidology, Thrombosis, and Prevention Committee of the Council on Nutrition, Physical Activity, and Metabolism; Council on Arteriosclerosis, Thrombosis and Vascular Biology; Council on Cardiovascular Nursing; Council on the Kidney in Cardiovascular Disease. Triglycerides and cardiovascular disease: a scientific statement from the American Heart Association. Circulation. 2011;123:2292-2333. doi: 10.1161/ CIR.0b013e3182160726.
47. Maki KC, Bays HE, Dicklin MR. Treatment options for the management of hypertriglyceridemia: strategies based on the best-available evidence. J Clin Lipidol. 2012;6:413-426. doi: 10.1016/j. jacl.2012.04.003.
48. Shearer GC, Savinova OV, Harris WS. Fish oil: how does it reduce plasma triglycerides? Biochim Biophys Acta. 2012;1821:843-851. doi: 10.1016/j.bbalip.2011.10.011.
49. Villani AM, Crotty M, Cleland LG, James MJ, Fraser RJ, Cobiac L, Miller MD. Fish oil administration in older adults with cardiovascular disease or cardiovascular risk factors: is there potential for adverse events? A systematic review of the literature. Int J Cardiol. 2013;168:4371-4375. doi: 10.1016/j.ijcard.2013.05.054.
50. Mozaffarian D, Rimm EB. Fish intake, contaminants, and human health: evaluating the risks and the benefits [published correction appears in JAMA. 2007;297:590]. JAMA. 2006;296:1885-1899. doi: 10.1001/jama.296.15.1885.
51. Adams J, Sibbritt D, Lui CW, Broom A, Wardle J. Ω-3 Fatty acid supplement use in the 45 and Up Study Cohort. BMJ Open. 2013;3:e002292. doi: 10.1136/bmjopen-2012-002292.
52. Perrin AE, Simon C, Hedelin G, Arveiler D, Schaffer P, Schlienger JL. Ten-year trends of dietary intake in a middle-aged French population: relationship with educational level. Eur J Clin Nutr. 2002;56:393-401. doi: 10.1038/sj.ejcn.1601322.
53. Marchioli R, Marfisi RM, Borrelli G, Chieffo C, Franzosi MG, Levantesi G, Maggioni AP, Nicolosi GL, Scarano M, Silletta MG, Schweiger C, Tavazzi L, Tognoni G. Efficacy of n-3 polyunsaturated fatty acids according to clinical characteristics of patients with recent myocardial infarction: insights from the GISSI-Prevenzione trial. J Cardiovasc Med (Hagerstown). 2007;8(suppl 1):S34-S37. doi: 10.2459/01.JCM.0000289271.80180.b6.