Effect of omega-3 fatty acids on cardiovascular outcomes: A systematic review and meta-analysis.

IF 10 1区医学 Q1 MEDICINE, GENERAL & INTERNAL EClinicalMedicine Pub Date : 2021-07-08 eCollection Date: 2021-08-01 DOI:10.1016/j.eclinm.2021.100997

Safi U Khan, Ahmad N Lone, Muhammad Shahzeb Khan, Salim S Virani, Roger S Blumenthal, Khurram Nasir, Michael Miller, Erin D Michos, Christie M Ballantyne, William E Boden, Deepak L Bhatt

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引用次数: 98

Abstract

Background: The effects of omega-3 fatty acids (FAs), such as eicosapentaenoic (EPA) and docosahexaenoic (DHA) acids, on cardiovascular outcomes are uncertain. We aimed to determine the effectiveness of omega-3 FAs on fatal and non-fatal cardiovascular outcomes and examine the potential variability in EPA vs. EPA+DHA treatment effects.

Methods: We searched EMBASE, PubMed, ClinicalTrials.gov, and Cochrane library databases through June 7, 2021. We performed a meta-analysis of 38 randomized controlled trials of omega-3 FAs, stratified by EPA monotherapy and EPA+DHA therapy. We estimated random-effects rate ratios (RRs) with (95% confidence intervals) and rated the certainty of evidence using GRADE. The key outcomes of interest were cardiovascular mortality, non-fatal cardiovascular outcomes, bleeding, and atrial fibrillation (AF). The protocol was registered in PROSPERO (CRD42021227580).

Findings: In 149,051 participants, omega-3 FA was associated with reducing cardiovascular mortality (RR, 0.93 [0.88-0.98]; p = 0.01), non-fatal myocardial infarction (MI) (RR, 0.87 [0.81-0.93]; p = 0.0001), coronary heart disease events (CHD) (RR, 0.91 [0.87-0.96]; p = 0.0002), major adverse cardiovascular events (MACE) (RR, 0.95 [0.92-0.98]; p = 0.002), and revascularization (RR, 0.91 [0.87-0.95]; p = 0.0001). The meta-analysis showed higher RR reductions with EPA monotherapy (0.82 [0.68-0.99]) than with EPA + DHA (0.94 [0.89-0.99]) for cardiovascular mortality, non-fatal MI (EPA: 0.72 [0.62-0.84]; EPA+DHA: 0.92 [0.85-1.00]), CHD events (EPA: 0.73 [0.62-0.85]; EPA+DHA: 0.94 [0.89-0.99]), as well for MACE and revascularization. Omega-3 FA increased incident AF (RR, 1.26 [1.08-1.48]). EPA monotherapy vs. control was associated with a higher risk of total bleeding (RR: 1.49 [1.20-1.84]) and AF (RR, 1.35 [1.10-1.66]).

Interpretation: Omega-3 FAs reduced cardiovascular mortality and improved cardiovascular outcomes. The cardiovascular risk reduction was more prominent with EPA monotherapy than with EPA+DHA.

Funding: None.

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omega-3脂肪酸对心血管预后的影响:一项系统综述和荟萃分析。

背景:omega-3脂肪酸(FAs)，如二十碳五烯酸(EPA)和二十二碳六烯酸(DHA)对心血管结局的影响尚不确定。我们的目的是确定omega-3脂肪酸对致死性和非致死性心血管结局的有效性，并检查EPA与EPA+DHA治疗效果的潜在变异性。方法:我们检索了EMBASE、PubMed、ClinicalTrials.gov和Cochrane图书馆数据库，截止日期为2021年6月7日。我们对38项omega-3脂肪酸的随机对照试验进行了荟萃分析，按EPA单药治疗和EPA+DHA治疗分层。我们使用(95%置信区间)估计随机效应比率(rr)，并使用GRADE对证据的确定性进行评级。关注的主要结局是心血管死亡率、非致命性心血管结局、出血和心房颤动(AF)。该协议已在PROSPERO (CRD42021227580)中注册。研究结果:在149,051名参与者中，omega-3 FA与降低心血管死亡率相关(RR, 0.93 [0.88-0.98];p = 0.01)、非致死性心肌梗死(MI) (RR, 0.87 [0.81-0.93];p = 0.0001)，冠心病事件(CHD) (RR, 0.91 [0.87-0.96];p = 0.0002)、主要心血管不良事件(MACE) (RR, 0.95 [0.92-0.98];p = 0.002)，血运重建术(RR, 0.91 [0.87-0.95];p = 0.0001)。荟萃分析显示，EPA单药治疗的心血管死亡率、非致死性心肌梗死(EPA: 0.72[0.62-0.84])的RR降低率(0.82[0.68-0.99])高于EPA + DHA (0.94 [0.89-0.99]);EPA + DHA: 0.92(0.85 - -1.00)),冠心病事件(环保局:0.73 (0.62 - -0.85);EPA+DHA: 0.94[0.89-0.99])，以及MACE和血运重建术。Omega-3 FA增加AF发生率(RR, 1.26[1.08-1.48])。EPA单药治疗与对照组相比，总出血(RR: 1.49[1.20-1.84])和房颤(RR, 1.35[1.10-1.66])的风险更高。解释:Omega-3脂肪酸降低了心血管死亡率，改善了心血管预后。EPA单药治疗比EPA+DHA治疗更能降低心血管风险。资金:没有。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

EClinicalMedicine Medicine-Medicine (all)

CiteScore

18.90

自引率

1.30%

发文量

506

审稿时长

22 days

期刊介绍： eClinicalMedicine is a gold open-access clinical journal designed to support frontline health professionals in addressing the complex and rapid health transitions affecting societies globally. The journal aims to assist practitioners in overcoming healthcare challenges across diverse communities, spanning diagnosis, treatment, prevention, and health promotion. Integrating disciplines from various specialties and life stages, it seeks to enhance health systems as fundamental institutions within societies. With a forward-thinking approach, eClinicalMedicine aims to redefine the future of healthcare.