Abstract
Background and Objectives: The clinical benefits of omega-3 fatty acid (FA) supplementation in preventing and treating cardiovascular disease remain controversial. The aim of this study was to investigate the effects of omega-3 FA administration on revascularization and adverse cardiovascular events including myocardial infarction, stroke, unstable angina, heart failure, and cardiovascular events/mortality using a meta-analytical approach. Methods: A comprehensive search of MEDLINE, Embase, Scopus, Web of Science, and Cochrane Library was performed throughout January 2023. Randomized controlled trials (RCTs) including at least 500 participants that compared the effects of omega-3 FA formulations (eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), or the combination) versus placebo or standard of care controls were considered eligible. Results: Our analysis included 17 RCTs that enrolled a total of 131,686 participants randomized to combined EPA + DHA (n = 52,498), EPA alone (n = 13,415), and control (n = 65,771). Overall, omega-3 FA supplementation was associated with reduced risk of revascularization [RR 0.91, 95% CI 0.84–0.99; phet = 0.0002; I2 = 69%; p = 0.02] and myocardial infarction [0.89, 95% CI 0.80–0.98; phet = 0.04; I2= 45%; p = 0.02] compared to controls, but had no significant effects on stroke, unstable angina, heart failure, or cardiovascular events/mortality. Comparing combined EPA + DHA with EPA, EPA alone was associated with a greater reduced risk of revascularization [0.76, 95% CI 0.63–0.94] and myocardial infarction [0.72, 95% CI 0.62–0.83], and a significantly reduced risk of stroke [0.72, 95% CI 0.55–0.95] and unstable angina [0.73, 95% CI 0.62–0.85]. No significant differences were observed according to EPA + DHA dose, EPA dose, and statin use. Conclusions: Omega-3 FA supplementation was associated with a reduced risk of revascularization and myocardial infarction compared with controls. The use of EPA alone appeared to be associated with even greater benefits, but further high-quality studies are needed to clarify the role of omega-3 FA supplementation in the primary and secondary prevention of cardiovascular disease.
Author Contributions
Conceptualization, F.S. and G.A.; methodology, M.D., F.S. and G.A.; software, M.D. and S.L.; formal analysis, M.D. and S.L.; writing—original draft preparation, M.D., S.L. and F.S.; writing—review and editing, A.V.M., G.F.G., G.A. and F.S.; visualization, M.D. and S.L.; funding acquisition, G.A. All authors have read and agreed to the published version of the manuscript.
Funding
This work has been partly supported by the Italian Ministry of Health - Ricerca Corrente to IRCCS MultiMedica.
Institutional Review Board Statement
Not applicable.
Informed Consent Statement
Not applicable.
Data Availability Statement
Data were from published information, retrieved through Medline, Embase, Scopus, Web-of-Science, and Cochrane Library.
Conflicts of Interest
The Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy, and the Center for Clinical and Translational Research—CERICLET, University of Perugia School of Medicine, Perugia, Italy, received an unconditioned research grant from Amarin, not shared with authors.
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2024 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).