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Long chain omega-3 fatty acids and cardiovascular disease: a systematic review

  • Javier Delgado-Lista (a1) (a2), Pablo Perez-Martinez (a1) (a2), Jose Lopez-Miranda (a1) (a2) and Francisco Perez-Jimenez (a1) (a2)
  • DOI:
  • Published online: 17 May 2012

Introduction: Cardiovascular disease remains the commonest health problem in developed countries, and residual risk after implementing all current therapies is still high. The use of marine omega-3 fatty acids (DHA and EPA) has been recommended to reduce cardiovascular risk by multiple mechanisms. Objectives: To update the current evidence on the influence of omega-3 on the rate of cardiovascular events. Review Methods: We used the MEDLINE and EMBASE databases to identify clinical trials and randomized controlled trials of omega-3 fatty acids (with quantified quantities) either in capsules or in dietary intake, compared to placebo or usual diet, equal to or longer than 6 months, and written in English. The primary outcome was a cardiovascular event of any kind and secondary outcomes were all-cause mortality, cardiac death and coronary events. We used RevMan 5·1 (Mantel-Haenszel method). Heterogeneity was assessed by the I2 and Chi2 tests. We included 21 of the 452 pre-selected studies. Results: We found an overall decrease of risk of suffering a cardiovascular event of any kind of 10 % (OR 0·90; [0·85–0·96], p = 0·001), a 9 % decrease of risk of cardiac death (OR 0·91; [0·83–0·99]; p = 0·03), a decrease of coronary events (fatal and non-fatal) of 18 % (OR 0·82; [0·75–0·90]; p < 1 × 10− 4), and a trend to lower total mortality (5 % reduction of risk; OR 0·95; [0·89–1·02]; p = 0·15. Most of the studies analyzed included persons with high cardiovascular risk. Conclusions: marine omega-3 fatty acids are effective in preventing cardiovascular events, cardiac death and coronary events, especially in persons with high cardiovascular risk.

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*Corresponding author: F. Perez-Jimenez, fax +34 957 204763, email
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1PM Kris-Etherton , WS Harris & LJ Appel (2002) Fish consumption, fish oil, omega-3 fatty acids, and cardiovascular disease. Circulation 106, 27472757.

2AH Lichtenstein , LJ Appel , M Brands , (2006) Diet and lifestyle recommendations revision 2006: a scientific statement from the American Heart Association Nutrition Committee. Circulation 114, 8296.

3CJ Lavie , RV Milani , MR Mehra , (2009) Omega-3 polyunsaturated fatty acids and cardiovascular diseases. J Am Coll Cardiol 54, 585594.

4A Mente , L de Koning , HS Shannon , (2009) A systematic review of the evidence supporting a causal link between dietary factors and coronary heart disease. Arch Intern Med 169, 659669.

5ND Riediger , RA Othman , M Suh , (2009) A systemic review of the roles of n-3 fatty acids in health and disease. J Am Diet Assoc 109, 668679.

6KB Filion , F El Khoury , M Bielinski , (2010) Omega-3 fatty acids in high-risk cardiovascular patients: a meta-analysis of randomized controlled trials. BMC Cardiovasc Disord 10, 24.

7AR Jadad , RA Moore , D Carroll , (1996) Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials 17, 112.

8GJ Dehmer , JJ Popma , EK van den Berg , (1988) Reduction in the rate of early restenosis after coronary angioplasty by a diet supplemented with n-3 fatty acids. N Engl J Med 319, 733740.

9ER Nye , MB Ablett , MC Robertson , (1990) Effect of eicosapentaenoic acid on restenosis rate, clinical course and blood lipids in patients after percutaneous transluminal coronary angioplasty. Aust N Z J Med 20, 549552.

10I Bairati , L Roy & F Meyer (1992) Double-blind, randomized, controlled trial of fish oil supplements in prevention of recurrence of stenosis after coronary angioplasty. Circulation 85, 950956.

11A Leaf , MB Jorgensen , AK Jacobs , (1994) Do fish oils prevent restenosis after coronary angioplasty? Circulation 90, 22482257.

12FM Sacks , PH Stone , CM Gibson , (1995) Controlled trial of fish oil for regression of human coronary atherosclerosis. HARP Research Group. J Am Coll Cardiol 25, 14921498.

13J Eritsland , H Arnesen , K Gronseth , (1996) Effect of dietary supplementation with n-3 fatty acids on coronary artery bypass graft patency. Am J Cardiol 77, 3136.

14GC Leng , AJ Lee , FG Fowkes , (1998) Randomized controlled trial of gamma-linolenic acid and eicosapentaenoic acid in peripheral arterial disease. Clin Nutr 17, 265271.

16O Johansen , M Brekke , I Seljeflot , (1999) 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, 16191626.

17C von Schacky , P Angerer , W Kothny , (1999) The effect of dietary omega-3 fatty acids on coronary atherosclerosis. A randomized, double-blind, placebo-controlled trial. Ann Intern Med 130, 554562.

19ML Burr , PA Ashfield-Watt , FD Dunstan , (2003) Lack of benefit of dietary advice to men with angina: results of a controlled trial. Eur J Clin Nutr 57, 193200.

20A Leaf , CM Albert , M Josephson , (2005) Prevention of fatal arrhythmias in high-risk subjects by fish oil n-3 fatty acid intake. Circulation 112, 27622768.

21MH Raitt , WE Connor , C Morris , (2005) Fish oil supplementation and risk of ventricular tachycardia and ventricular fibrillation in patients with implantable defibrillators: a randomized controlled trial. JAMA 293, 28842891.

22IA Brouwer , PL Zock , AJ Camm , (2006) 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, 26132619.

23M Yokoyama , H Origasa , M Matsuzaki , (2007) Effects of eicosapentaenoic acid on major coronary events in hypercholesterolaemic patients (JELIS): a randomised open-label, blinded endpoint analysis. Lancet 369, 10901098.

24HFI Gissi , L Tavazzi , AP Maggioni , (2008) Effect of n-3 polyunsaturated fatty acids in patients with chronic heart failure (the GISSI-HF trial): a randomised, double-blind, placebo-controlled trial. Lancet 372, 12231230.

25G Einvik , TO Klemsdal , L Sandvik , (2010) 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, 588592.

26P Galan , E Kesse-Guyot , S Czernichow , (2010) Effects of B vitamins and omega 3 fatty acids on cardiovascular diseases: a randomised placebo controlled trial. BMJ 341, c6273.

27B Rauch , R Schiele , S Schneider , (2010) 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, 21522159.

28S Nodari , M Triggiani , U Campia , (2011) Effects of n-3 polyunsaturated fatty acids on left ventricular function and functional capacity in patients with dilated cardiomyopathy. J Am Coll Cardiol 57, 870879.

29D Kromhout , EJ Giltay , JM Geleijnse , (2010) n-3 fatty acids and cardiovascular events after myocardial infarction. N Engl J Med 363, 20152026.

30C von Schacky & WS Harris (2007) Cardiovascular benefits of omega-3 fatty acids. Cardiovasc Res 73, 310315.

32PE Marik & J Varon (2009) Omega-3 dietary supplements and the risk of cardiovascular events: a systematic review. Clin Cardiol 32, 365372.

33P Saravanan , NC Davidson , EB Schmidt , (2010) Cardiovascular effects of marine omega-3 fatty acids. Lancet 376, 540550.

34RB Singh , MA Niaz , JP Sharma , (1997) 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, 485491.

35R Horton (2005) Expression of concern: Indo-Mediterranean Diet Heart Study. Lancet 366, 354356.

36C White (2005) Suspected research fraud: difficulties of getting at the truth. BMJ 331, 281288.

37H Iso , M Kobayashi , J Ishihara , (2006) 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, 195202.

38N Watanabe , Y Watanabe , M Kumagai , (2009) Administration of dietary fish oil capsules in healthy middle-aged Japanese men with a high level of fish consumption. Int J Food Sci Nutr 60, Suppl. 5, 136142.

39H Origasa , M Yokoyama , M Matsuzaki , (2010) Clinical importance of adherence to treatment with eicosapentaenoic acid by patients with hypercholesterolemia. Circ J 74, 510517.

40D Mozaffarian (2007) Fish, n-3 fatty acids, and cardiovascular haemodynamics. J Cardiovasc Med (Hagerstown) 8, Suppl. 1, S23S26.

41P Perez-Martinez , J Delgado-Lista , F Perez-Jimenez , (2010) Update on genetics of postprandial lipemia. Atheroscler Suppl 11, 3943.

42TM Teslovich , K Musunuru , AV Smith , (2010) Biological, clinical and population relevance of 95 loci for blood lipids. Nature 466, 707713.

43H Pishva , SA Mahboob , P Mehdipour , (2010) Fatty acid-binding protein-2 genotype influences lipid and lipoprotein response to eicosapentaenoic acid supplementation in hypertriglyceridemic subjects. Nutrition 26, 11171121.

44E Olano-Martin , E Anil , MJ Caslake , (2010) Contribution of apolipoprotein E genotype and docosahexaenoic acid to the LDL-cholesterol response to fish oil. Atherosclerosis 209, 104110.

46D Mozaffarian & EB Rimm (2006) Fish intake, contaminants, and human health: evaluating the risks and the benefits. JAMA 296, 18851899.

47F Thies , JM Garry , P Yaqoob , (2003) Association of n-3 polyunsaturated fatty acids with stability of atherosclerotic plaques: a randomised controlled trial. Lancet 361, 477485.

48WS Harris , M Miller , AP Tighe , (2008) Omega-3 fatty acids and coronary heart disease risk: clinical and mechanistic perspectives. Atherosclerosis 197, 1224.

49CN Serhan , N Chiang & TE Van Dyke (2008) Resolving inflammation: dual anti-inflammatory and pro-resolution lipid mediators. Nat Rev Immunol 8, 349361.

50MC Morris , F Sacks & B Rosner (1993) Does fish oil lower blood pressure? A meta-analysis of controlled trials. Circulation 88, 523533.

51K Yamagishi , JA Nettleton & AR Folsom (2008) Plasma fatty acid composition and incident heart failure in middle-aged adults: the Atherosclerosis Risk in Communities (ARIC) Study. Am Heart J 156, 965974.

52D Mozaffarian , BM Psaty , EB Rimm , (2004) Fish intake and risk of incident atrial fibrillation. Circulation 110, 368373.

53L Gillet , S Roger , P Bougnoux , (2011) Beneficial effects of omega-3 long-chain fatty acids in breast cancer and cardiovascular diseases: voltage-gated sodium channels as a common feature? Biochimie 93, 46.

54P Saravanan , B Bridgewater , AL West , (2010) 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 3, 4653.

55IA Brouwer , MH Raitt , C Dullemeijer , (2009) Effect of fish oil on ventricular tachyarrhythmia in three studies in patients with implantable cardioverter defibrillators. Eur Heart J 30, 820826.

56AO Verkerk , AC van Ginneken , G Berecki , (2006) Incorporated sarcolemmal fish oil fatty acids shorten pig ventricular action potentials. Cardiovasc Res 70, 509520.

57R Coronel , FJ Wilms-Schopman , HM Den Ruijter , (2007) Dietary n-3 fatty acids promote arrhythmias during acute regional myocardial ischemia in isolated pig hearts. Cardiovasc Res 73, 386394.

59S Chalupka (2009) Omega-3 polyunsaturated fatty acid in primary and secondary cardiovascular disease prevention. AAOHN J 57, 480.

60HR Knapp , IA Reilly , P Alessandrini , (1986) In vivo indexes of platelet and vascular function during fish-oil administration in patients with atherosclerosis. N Engl J Med 314, 937942.

61SD Kristensen , AM Iversen & EB Schmidt (2001) n-3 polyunsaturated fatty acids and coronary thrombosis. Lipids 36, S79S82.

62J Eritsland , H Arnesen , I Seljeflot , (1995) Long-term effects of n-3 polyunsaturated fatty acids on haemostatic variables and bleeding episodes in patients with coronary artery disease. Blood Coagul Fibrinolysis 6, 1722.

63PD Watson , PS Joy , C Nkonde , (2009) Comparison of bleeding complications with omega-3 fatty acids+aspirin+clopidogrel–versus–aspirin+clopidogrel in patients with cardiovascular disease. Am J Cardiol 104, 10521054.

64K Park & D Mozaffarian (2010) Omega-3 fatty acids, mercury, and selenium in fish and the risk of cardiovascular diseases. Curr Atheroscler Rep 12, 414422.

65L Fremont , MT Gozzelino , MP Franchi , (1998) Dietary flavonoids reduce lipid peroxidation in rats fed polyunsaturated or monounsaturated fat diets. J Nutr 128, 14951502.

66MF Hau , AH Smelt , AJ Bindels , (1996) Effects of fish oil on oxidation resistance of VLDL in hypertriglyceridemic patients. Arterioscler Thromb Vasc Biol 16, 11971202.

67NS Sorensen , P Marckmann , CE Hoy , (1998) Effect of fish-oil-enriched margarine on plasma lipids, low-density-lipoprotein particle composition, size, and susceptibility to oxidation. Am J Clin Nutr 68, 235241.

69IR Brude , CA Drevon , I Hjermann , (1997) Peroxidation of LDL from combined-hyperlipidemic male smokers supplied with omega-3 fatty acids and antioxidants. Arterioscler Thromb Vasc Biol 17, 25762588.

71H Petersson , U Riserus , J McMonagle , (2010) Effects of dietary fat modification on oxidative stress and inflammatory markers in the LIPGENE study. Br J Nutr 104, 13571362.

72A Leaf , JX Kang , YF Xiao , (2003) Clinical prevention of sudden cardiac death by n-3 polyunsaturated fatty acids and mechanism of prevention of arrhythmias by n-3 fish oils. Circulation 107, 26462652.

73GC Leng , GS Taylor , AJ Lee , (1999) Essential fatty acids and cardiovascular disease: the Edinburgh Artery Study. Vasc Med 4, 219226.

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