PMID 32114706 Omega-3 fatty acids for the primary and secondary prevention of cardiovascular disease Meta-analysis (Cochrane) · Cochrane Database Syst Rev, 2020 86 RCTRandomized controlled trial - a high-reliability trial that randomly assigns participants to compare effects.s, 160,000 people - omega-3 barely reduced all-cause or cardiovascular death or cardiovascular events, but lowered triglycerideA type of fat in the blood; high levels raise cardiovascular risk.s by about 15%.
Key summary
A CochraneAn international network that rigorously reviews and synthesizes evidence. review pooling 86 RCTRandomized controlled trial - a high-reliability trial that randomly assigns participants to compare effects.s and 162,796 participants. Long-chain omega-3 (EPAAn omega-3 fatty acid (eicosapentaenoic acid).·DHAAn omega-3 fatty acid (docosahexaenoic acid).) supplementation did not significantly reduce all-cause mortality (RR 0.97), cardiovascular death, cardiovascular events (RR 0.96), or stroke (high to moderate certainty). Coronary death (RR 0.90) and coronary events (RR 0.91) may fall slightly, but at low certainty. By contrast, triglycerideA type of fat in the blood; high levels raise cardiovascular risk.s were lowered by about 15% in a dose-dependent way (high certainty). The effect of plant-based ALAAlpha-linolenic acid - plant omega-3; poorly converted to EPA/DHA in the body. was smaller.
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BACKGROUND: Omega-3 polyunsaturated fatty acids from oily fish (long-chain omega-3 (LCn3)), including eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA)), as well as from plants (alpha-linolenic acid (ALA)) may benefit cardiovascular health. Guidelines recommend increasing omega-3-rich foods, and sometimes supplementation, but recent trials have not confirmed this. OBJECTIVES: To assess the effects of increased intake of fish- and plant-based omega-3 fats for all-cause mortality, cardiovascular events, adiposity and lipids. MAIN RESULTS: We included 86 RCTs (162,796 participants) in this review update and found that 28 were at low summary risk of bias. LCn3 doses ranged from 0.5 g a day to more than 5 g a day. Meta-analysis and sensitivity analyses suggested little or no effect of increasing LCn3 on all-cause mortality (risk ratio (RR) 0.97, 95% confidence interval (CI) 0.93 to 1.01; 143,693 participants; 11,297 deaths in 45 RCTs; high-certainty evidence), cardiovascular mortality (RR 0.92, 95% CI 0.86 to 0.99; moderate-certainty evidence), cardiovascular events (RR 0.96, 95% CI 0.92 to 1.01; high-certainty evidence), stroke (RR 1.02, 95% CI 0.94 to 1.12) or arrhythmia (RR 0.99, 95% CI 0.92 to 1.06). Increasing LCn3 may slightly reduce coronary heart disease mortality (NNTB 334, RR 0.90, 95% CI 0.81 to 1.00; low-certainty evidence) and coronary heart disease events (NNTB 167, RR 0.91, 95% CI 0.85 to 0.97; low-certainty evidence). Increasing LCn3 and ALA had little or no effect on serious adverse events, adiposity, lipids and blood pressure, except increasing LCn3 reduced triglycerides by ˜15% in a dose-dependent way (high-certainty evidence). AUTHORS' CONCLUSIONS: Moderate- and low-certainty evidence suggests that increasing LCn3 slightly reduces risk of coronary heart disease mortality and events, and reduces serum triglycerides (evidence mainly from supplement trials). ※ The abstract text as collected and stored via the API by the pipeline. The key summary is written based solely on this text.
View original ↗ PMID 30415637 Marine n-3 Fatty Acids and Prevention of Cardiovascular Disease and Cancer (VITAL) RCT · N Engl J Med, 2019 General population of 25,871 - fish oil 1 g a day did not reduce major cardiovascular events or cancer versus placeboAn inert dummy treatment used as the comparison baseline..
Key summary
A large randomized trial (VITAL) in 25,871 U.S. men aged 50 and older and women aged 55 and older. Marine n-3 (1 g a day) did not significantly reduce major cardiovascular events (a composite of myocardial infarctionA heart attack - death of heart muscle from blocked blood flow., stroke, and cardiovascular death) versus placeboAn inert dummy treatment used as the comparison baseline. (hazard ratio 0.92, 95% CI 0.80–1.06), nor did it reduce cancer incidence. Total myocardial infarction was slightly lower (hazard ratio 0.72). The finding is that there is no evidence that low-dose fish oil prevents cardiovascular disease in the general population.
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BACKGROUND: Higher intake of marine n-3 (also called omega-3) fatty acids has been associated with reduced risks of cardiovascular disease and cancer in several observational studies. Whether supplementation with n-3 fatty acids has such effects in general populations at usual risk for these end points is unclear. METHODS: We conducted a randomized, placebo-controlled trial, with a two-by-two factorial design, of vitamin D3 (2000 IU per day) and marine n-3 fatty acids (1 g per day) in the primary prevention of cardiovascular disease and cancer among men 50 years of age or older and women 55 years of age or older in the United States. Primary end points were major cardiovascular events (a composite of myocardial infarction, stroke, or death from cardiovascular causes) and invasive cancer of any type. RESULTS: A total of 25,871 participants underwent randomization. During a median follow-up of 5.3 years, a major cardiovascular event occurred in 386 participants in the n-3 group and in 419 in the placebo group (hazard ratio, 0.92; 95% confidence interval [CI], 0.80 to 1.06; P=0.24). Invasive cancer was diagnosed in 820 participants in the n-3 group and in 797 in the placebo group (hazard ratio, 1.03; 95% CI, 0.93 to 1.13; P=0.56). For total myocardial infarction the hazard ratio was 0.72 (95% CI, 0.59 to 0.90); for total stroke, 1.04 (95% CI, 0.83 to 1.31); for death from cardiovascular causes, 0.96 (95% CI, 0.76 to 1.21). CONCLUSIONS: Supplementation with n-3 fatty acids did not result in a lower incidence of major cardiovascular events or cancer than placebo. (VITAL ClinicalTrials.gov number, NCT01169259.). ※ The abstract text as collected and stored via the API by the pipeline. The key summary is written based solely on this text.
View original ↗ PMID 30146932 Effects of n-3 Fatty Acid Supplements in Diabetes Mellitus (ASCEND) RCT · N Engl J Med, 2018 15,480 patients with diabetes - fish oil 1 g a day did not reduce serious vascular events versus placeboAn inert dummy treatment used as the comparison baseline..
Key summary
A large randomized trial (ASCEND) in 15,480 patients with diabetes but without cardiovascular disease. Supplementation with 1 g a day of n-3 fatty acids did not significantly reduce serious vascular events (nonfatal myocardial infarctionA heart attack - death of heart muscle from blocked blood flow., stroke, transient ischemic attack, or vascular death) versus placeboAn inert dummy treatment used as the comparison baseline. (olive oil) over a mean 7.4 years of follow-up (rate ratio 0.97, 95% CI 0.87–1.08). Even in patients with diabetes, there was no cardiovascular-prevention benefit from low-dose fish oil.
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BACKGROUND: Increased intake of n-3 fatty acids has been associated with a reduced risk of cardiovascular disease in observational studies, but this finding has not been confirmed in randomized trials. It remains unclear whether n-3 (also called omega-3) fatty acid supplementation has cardiovascular benefit in patients with diabetes mellitus. METHODS: We randomly assigned 15,480 patients with diabetes but without evidence of atherosclerotic cardiovascular disease to receive 1-g capsules containing either n-3 fatty acids (fatty acid group) or matching placebo (olive oil) daily. The primary outcome was a first serious vascular event (i.e., nonfatal myocardial infarction or stroke, transient ischemic attack, or vascular death, excluding confirmed intracranial hemorrhage). RESULTS: During a mean follow-up of 7.4 years (adherence rate, 76%), a serious vascular event occurred in 689 patients (8.9%) in the fatty acid group and in 712 (9.2%) in the placebo group (rate ratio, 0.97; 95% confidence interval [CI], 0.87 to 1.08; P=0.55). Death from any cause occurred in 752 patients (9.7%) in the fatty acid group and in 788 (10.2%) in the placebo group (rate ratio, 0.95; 95% CI, 0.86 to 1.05). CONCLUSIONS: Among patients with diabetes without evidence of cardiovascular disease, there was no significant difference in the risk of serious vascular events between those who were assigned to receive n-3 fatty acid supplementation and those who were assigned to receive placebo. (ASCEND ClinicalTrials.gov number, NCT00135226.). ※ The abstract text as collected and stored via the API by the pipeline. The key summary is written based solely on this text.
View original ↗ PMID 30415628 Cardiovascular Risk Reduction with Icosapent Ethyl for Hypertriglyceridemia (REDUCE-IT) RCT · N Engl J Med, 2019 8,179 statinA common lipid-lowering drug that reduces LDL cholesterol.-treated, high-triglycerideA type of fat in the blood; high levels raise cardiovascular risk., high-risk patients - high-dose prescription EPAAn omega-3 fatty acid (eicosapentaenoic acid). (4 g) reduced major cardiovascular events by 25%.
Key summary
A randomized trial (REDUCE-IT) in 8,179 high-cardiovascular-risk patients who still had high triglycerideA type of fat in the blood; high levels raise cardiovascular risk.s (135–499 mg/dL) despite statinA common lipid-lowering drug that reduces LDL cholesterol. treatment. High-purity prescription EPAAn omega-3 fatty acid (eicosapentaenoic acid). (icosapent ethylA high-purity prescription form of EPA. 2 g twice daily, 4 g/day total) reduced major cardiovascular events by 25% versus placeboAn inert dummy treatment used as the comparison baseline. (hazard ratio 0.75) and also lowered cardiovascular death. However, hospitalizations for atrial fibrillationAn irregular, rapid heart rhythm arising in the atria. or flutter (3.1% vs 2.1%) and a trend toward serious bleeding increased. This is a result confined to high-dose prescription EPA and a high-risk group.
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BACKGROUND: Patients with elevated triglyceride levels are at increased risk for ischemic events. Icosapent ethyl, a highly purified eicosapentaenoic acid ethyl ester, lowers triglyceride levels, but data are needed to determine its effects on ischemic events. METHODS: We performed a multicenter, randomized, double-blind, placebo-controlled trial involving patients with established cardiovascular disease or with diabetes and other risk factors, who had been receiving statin therapy and who had a fasting triglyceride level of 135 to 499 mg per deciliter and a low-density lipoprotein cholesterol level of 41 to 100 mg per deciliter. The patients were randomly assigned to receive 2 g of icosapent ethyl twice daily (total daily dose, 4 g) or placebo. The primary end point was a composite of cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, coronary revascularization, or unstable angina. RESULTS: A total of 8179 patients were enrolled and were followed for a median of 4.9 years. A primary end-point event occurred in 17.2% of the patients in the icosapent ethyl group, as compared with 22.0% of the patients in the placebo group (hazard ratio, 0.75; 95% confidence interval [CI], 0.68 to 0.83; P<0.001). The rate of cardiovascular death was 4.3% vs. 5.2% (hazard ratio, 0.80; 95% CI, 0.66 to 0.98; P=0.03). A larger percentage of patients in the icosapent ethyl group than in the placebo group were hospitalized for atrial fibrillation or flutter (3.1% vs. 2.1%, P=0.004). Serious bleeding events occurred in 2.7% of the patients in the icosapent ethyl group and in 2.1% in the placebo group (P=0.06). CONCLUSIONS: Among patients with elevated triglyceride levels despite the use of statins, the risk of ischemic events, including cardiovascular death, was significantly lower among those who received 2 g of icosapent ethyl twice daily than among those who received placebo. (REDUCE-IT ClinicalTrials.gov number, NCT01492361.). ※ The abstract text as collected and stored via the API by the pipeline. The key summary is written based solely on this text.
View original ↗ PMID 31422671 Omega-3 Fatty Acids for the Management of Hypertriglyceridemia: A Science Advisory From the American Heart Association Scientific advisory (AHA) · Circulation, 2019 American Heart Association - prescription omega-3 at 4 g a day is an effective, safe option that lowers triglycerideA type of fat in the blood; high levels raise cardiovascular risk.s by more than 30%.
Key summary
An American Heart Association (AHA) science advisory. High-dose prescription omega-3 (more than 3 g/day total EPAAn omega-3 fatty acid (eicosapentaenoic acid).+DHAAn omega-3 fatty acid (docosahexaenoic acid)., typically 4 g) lowers very high triglycerideA type of fat in the blood; high levels raise cardiovascular risk.s by more than 30%, and EPA+DHA and EPA-only are broadly comparable for triglyceride lowering. EPA-only does not raise LDLLow-density lipoprotein cholesterol - the so-called "bad" cholesterol.. The advisory concluded that it is an effective and safe option for lowering triglycerides, whether as monotherapy or combined with a statinA common lipid-lowering drug that reduces LDL cholesterol..
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Hypertriglyceridemia (triglycerides 200-499 mg/dL) is relatively common in the United States, whereas more severe triglyceride elevations (very high triglycerides, ≥500 mg/dL) are far less frequently observed. In a 2002 American Heart Association scientific statement, the omega-3 fatty acids (n-3 FAs) eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) were recommended (at a dose of 2-4 g/d) for reducing triglycerides in patients with elevated triglycerides. The purpose of this advisory is to summarize the lipid and lipoprotein effects resulting from pharmacological doses of n-3 FAs (>3 g/d total EPA+DHA). In treatment of very high triglycerides with 4 g/d, EPA+DHA agents reduce triglycerides by ≥30% with concurrent increases in low-density lipoprotein cholesterol, whereas EPA-only did not raise low-density lipoprotein cholesterol in very high triglycerides. When used to treat hypertriglyceridemia, n-3 FAs with EPA+DHA or with EPA-only appear roughly comparable for triglyceride lowering and do not increase low-density lipoprotein cholesterol when used as monotherapy or in combination with a statin. The use of n-3 FA (4 g/d) for improving atherosclerotic cardiovascular disease risk in patients with hypertriglyceridemia is supported by a 25% reduction in major adverse cardiovascular events in REDUCE-IT, a randomized placebo-controlled trial of EPA-only in high-risk patients treated with a statin. We conclude that prescription n-3 FAs (EPA+DHA or EPA-only) at a dose of 4 g/d (>3 g/d total EPA+DHA) are an effective and safe option for reducing triglycerides as monotherapy or as an adjunct to other lipid-lowering agents. ※ The abstract text as collected and stored via the API by the pipeline. The key summary is written based solely on this text.
View original ↗ PMID 31567003 Marine Omega-3 Supplementation and Cardiovascular Disease: An Updated Meta-Analysis of 13 Randomized Controlled Trials Involving 127 477 Participants Meta-analysis · J Am Heart Assoc, 2019 13 RCTRandomized controlled trial - a high-reliability trial that randomly assigns participants to compare effects.s, 127,000 people - fish oil slightly lowered myocardial infarctionA heart attack - death of heart muscle from blocked blood flow. and coronary death (by 7–8%), in a dose-dependent way.
Key summary
A meta-analysisA statistical synthesis combining results of multiple studies into one conclusion. pooling 13 RCTRandomized controlled trial - a high-reliability trial that randomly assigns participants to compare effects.s and 127,477 participants. Even excluding REDUCE-IT, marine omega-3 supplementation produced small but statistically significant reductions in myocardial infarctionA heart attack - death of heart muscle from blocked blood flow. (RR 0.92), coronary death (0.92), total coronary heart diseaseDisease caused by narrowing of the arteries that supply the heart. (0.95), cardiovascular death (0.93), and total cardiovascular disease (0.97). The risk reduction was proportional to the dose. The absolute reduction is small.
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Background Whether marine omega-3 supplementation is associated with reduction in risk of cardiovascular disease (CVD) remains controversial. Methods and Results This meta-analysis included study-level data from 13 trials. The outcomes of interest included myocardial infarction, coronary heart disease (CHD) death, total CHD, total stroke, CVD death, total CVD, and major vascular events. During a mean treatment duration of 5.0 years, in the analysis excluding REDUCE-IT, marine omega-3 supplementation was associated with significantly lower risk of myocardial infarction (rate ratio [RR] [95% CI]: 0.92 [0.86, 0.99]; P=0.020), CHD death (RR 0.92 [0.86, 0.98]; P=0.014), total CHD (RR 0.95 [0.91, 0.99]; P=0.008), CVD death (RR 0.93 [0.88, 0.99]; P=0.013), and total CVD (RR 0.97 [0.94, 0.99]; P=0.015). Inverse associations for all outcomes were strengthened after including REDUCE-IT. Statistically significant linear dose-response relationships were found for total CVD and major vascular events. Conclusions Marine omega-3 supplementation lowers risk for myocardial infarction, CHD death, total CHD, CVD death, and total CVD, even after exclusion of REDUCE-IT. Risk reductions appeared to be linearly related to marine omega-3 dose. ※ The abstract text as collected and stored via the API by the pipeline. The key summary is written based solely on this text.
View original ↗ PMID 30480773 Omega-3 fatty acid addition during pregnancy Meta-analysis (Cochrane) · Cochrane Database Syst Rev, 2018 70 RCTRandomized controlled trial - a high-reliability trial that randomly assigns participants to compare effects.s, about 20,000 people - omega-3 during pregnancy reduced preterm birthBirth before 37 weeks of pregnancy. (before 37 weeks) and early preterm birth (before 34 weeks) (high quality).
Key summary
A CochraneAn international network that rigorously reviews and synthesizes evidence. review pooling 70 RCTRandomized controlled trial - a high-reliability trial that randomly assigns participants to compare effects.s and 19,927 pregnant women. Omega-3 supplementation during pregnancy reduced preterm birthBirth before 37 weeks of pregnancy. before 37 weeks (13.4% to 11.9%, RR 0.89) and early preterm birth before 34 weeks (4.6% to 2.7%, RR 0.58) (both high-quality evidence). Low-birthweight babies also fell, and perinatal death and neonatal intensive-care admission may fall as well. However, prolonged pregnancy beyond 42 weeks may rise slightly.
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BACKGROUND: Higher intakes of foods containing omega-3 long-chain polyunsaturated fatty acids (LCPUFA), such as fish, during pregnancy have been associated with longer gestations and improved perinatal outcomes. OBJECTIVES: To assess the effects of omega-3 LCPUFA, as supplements or as dietary additions, during pregnancy on maternal, perinatal, and neonatal outcomes and longer-term outcomes for mother and child. MAIN RESULTS: In this update, we included 70 RCTs (involving 19,927 women at low, mixed or high risk of poor pregnancy outcomes). Preterm birth < 37 weeks (13.4% versus 11.9%; risk ratio (RR) 0.89, 95% confidence interval (CI) 0.81 to 0.97; 26 RCTs, 10,304 participants; high-quality evidence) and early preterm birth < 34 weeks (4.6% versus 2.7%; RR 0.58, 95% CI 0.44 to 0.77; 9 RCTs, 5204 participants; high-quality evidence) were both lower in women who received omega-3 LCPUFA compared with no omega-3. Prolonged gestation > 42 weeks was probably increased from 1.6% to 2.6% (RR 1.61, 95% CI 1.11 to 2.33; moderate-quality evidence). There was a reduced risk of low birthweight (LBW) babies (RR 0.90, 95% CI 0.82 to 0.99; high-quality evidence). AUTHORS' CONCLUSIONS: Omega-3 LCPUFA supplementation during pregnancy is an effective strategy for reducing the incidence of preterm birth, although it probably increases the incidence of post-term pregnancies. ※ The abstract text as collected and stored via the API by the pipeline. The key summary is written based solely on this text.
View original ↗ FDA (openFDA) Omega-3-acid ethyl esters (prescription fish oil) - drug label (warnings and interactions)
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View original ↗ USDA FoodData Central Fish, salmon, Atlantic, farmed, cooked, dry heat (FDC 175168)
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View original ↗ USDA FoodData Central Fish, mackerel, Atlantic, cooked, dry heat (FDC 175120)
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View original ↗ USDA FoodData Central Fish, herring, Atlantic, cooked, dry heat (FDC 175117)
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View original ↗ USDA FoodData Central Fish, sardine, Atlantic, canned in oil, drained solids with bone (FDC 175139)
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View original ↗ USDA FoodData Central Fish, anchovy, european, canned in oil, drained solids (FDC 174183)
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