Context:
Considerable controversy exists
regarding the association of omega-3 polyunsaturated fatty acids
(PUFAs) and major cardiovascular end points.
Objective:
To assess the role of omega-3
supplementation on major cardiovascular outcomes.
Data Sources MEDLINE, EMBASE, and
the Cochrane Central Register of Controlled Trials through August
2012.
Study Selection:
Randomized clinical trials evaluating
the effect of omega-3 on all-cause mortality, cardiac death, sudden
death, myocardial infarction, and stroke.
Data Extraction:
Descriptive and quantitative
information was extracted; absolute and relative risk (RR) estimates
were synthesized under a random-effects model. Heterogeneity was
assessed using the Q statistic and I2. Subgroup analyses were
performed for the presence of blinding, the prevention settings, and
patients with implantable cardioverter-defibrillators, and
meta-regression analyses were performed for the omega-3 dose. A
statistical significance threshold of .0063 was assumed after
adjustment for multiple comparisons.
Data Synthesis:
Of the 3635 citations retrieved, 20
studies of 68 680 patients were included, reporting 7044 deaths,
3993 cardiac deaths, 1150 sudden deaths, 1837 myocardial infarctions,
and 1490 strokes. No statistically significant association was
observed with all-cause mortality (RR, 0.96; 95% CI, 0.91 to 1.02;
risk reduction [RD] −0.004, 95% CI, −0.01 to 0.02), cardiac death
(RR, 0.91; 95% CI, 0.85 to 0.98; RD, −0.01; 95% CI, −0.02 to
0.00), sudden death (RR, 0.87; 95% CI, 0.75 to 1.01; RD, −0.003;
95% CI, −0.012 to 0.006), myocardial infarction (RR, 0.89; 95% CI,
0.76 to 1.04; RD, −0.002; 95% CI, −0.007 to 0.002), and stroke
(RR, 1.05; 95% CI, 0.93 to 1.18; RD, 0.001; 95% CI, −0.002 to
0.004) when all supplement studies were considered.
Conclusion:
Overall, omega-3 PUFA supplementation
was not associated with a lower risk of all-cause mortality, cardiac
death, sudden death, myocardial infarction, or stroke based on
relative and absolute measures of association.
JAMA. 2012;308(10):1024-1033.
doi:10.1001/2012.jama.11374
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