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Article

All-Cause Mortality and Cardiovascular Death between Statins and Omega-3 Supplementation: A Meta-Analysis and Network Meta-Analysis from 55 Randomized Controlled Trials

by
Jeongseon Kim
1,*,†,
Tung Hoang
1,†,
Ji-Myung Kim
2,
So Young Bu
3,
Jeong-Hwa Choi
4,
Eunju Park
5,
Seung-Min Lee
6,
Eunmi Park
7,
Ji Yeon Min
8,
In Seok Lee
9,
So Young Youn
10 and
Jee-Young Yeon
11
1
Department of Cancer Biomedical Science, National Cancer Center Graduate School of Cancer Science and Policy, Goyang 10408, Korea
2
Food and Nutrition Major, Division of Food Science and Culinary Arts, Shinhan University, Uijeongbu 11644, Korea
3
Department of Food and Nutrition, Daegu University, Gyeongsan 38453, Korea
4
Department of Food and Nutrition, Keimyung University, Daegu 42601, Korea
5
Department of Food and Nutrition, Kyungnam University, Changwon 51767, Korea
6
Department of Food and Nutrition, Yonsei University, Seoul 03722, Korea
7
Department of Food and Nutrition, Hannam University, Daejeon 34430, Korea
8
Dietetics and Nutrition Services Team, Asan Medical Center, Seoul 05505, Korea
9
Nutrition Support Team, Kyung Hee University Medical Center, Seoul 02447, Korea
10
Clinical Nutrition Part, Samsung Medical Center, Seoul 06351, Korea
11
Department of Food and Nutrition, Seowon University, Cheongju 28674, Korea
 
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*
Author to whom correspondence should be addressed.
†
These authors contributed equally to this work.
Nutrients 2020, 12(10), 3203; https://doi.org/10.3390/nu12103203
Submission received: 24 September 2020 / Revised: 17 October 2020 / Accepted: 19 October 2020 / Published: 20 October 2020
(This article belongs to the Section Clinical Nutrition)
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Abstract

Statins and omega-3 supplementation have shown potential benefits in preventing cardiovascular disease (CVD), but their comparative effects on mortality outcomes, in addition to primary and secondary prevention and mixed population, have not been investigated. This study aimed to examine the effect of statins and omega-3 supplementation and indirectly compare the effects of statin use and omega-3 fatty acids on all-cause mortality and CVD death. We included randomized controlled trials (RCTs) from meta-analyses published until December 2019. Pooled relative risks (RRs) and 95% confidence intervals (CIs) were calculated to indirectly compare the effect of statin use versus omega-3 supplementation in a frequentist network meta-analysis. In total, 55 RCTs were included in the final analysis. Compared with placebo, statins were significantly associated with a decreased the risk of all-cause mortality (RR = 0.90, 95% CI = 0.86–0.94) and CVD death (RR = 0.86, 95% CI = 0.80–0.92), while omega-3 supplementation showed a borderline effect on all-cause mortality (RR = 0.97, 95% CI = 0.94–1.01) but were significantly associated with a reduced risk of CVD death (RR = 0.92, 95% CI = 0.87–0.98) in the meta-analysis. The network meta-analysis found that all-cause mortality was significantly different between statin use and omega-3 supplementation for overall population (RR = 0.91, 95% CI = 0.85–0.98), but borderline for primary prevention and mixed population and nonsignificant for secondary prevention. Furthermore, there were borderline differences between statin use and omega-3 supplementation in CVD death in the total population (RR = 0.92, 95% CI = 0.82–1.04) and primary prevention (RR = 0.85, 95% CI = 0.68–1.05), but nonsignificant differences in secondary prevention (RR = 0.97, 95% CI = 0.66–1.43) and mixed population (RR = 0.92, 95% CI = 0.75–1.14). To summarize, statin use might be associated with a lower risk of all-cause mortality than omega-3 supplementation. Future direct comparisons between statin use and omega-3 supplementation are required to confirm the findings.
Keywords: cardiovascular disease; mortality; statin; omega-3; network meta-analysis cardiovascular disease; mortality; statin; omega-3; network meta-analysis

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MDPI and ACS Style

Kim, J.; Hoang, T.; Kim, J.-M.; Bu, S.Y.; Choi, J.-H.; Park, E.; Lee, S.-M.; Park, E.; Min, J.Y.; Lee, I.S.; et al. All-Cause Mortality and Cardiovascular Death between Statins and Omega-3 Supplementation: A Meta-Analysis and Network Meta-Analysis from 55 Randomized Controlled Trials. Nutrients 2020, 12, 3203. https://doi.org/10.3390/nu12103203

AMA Style

Kim J, Hoang T, Kim J-M, Bu SY, Choi J-H, Park E, Lee S-M, Park E, Min JY, Lee IS, et al. All-Cause Mortality and Cardiovascular Death between Statins and Omega-3 Supplementation: A Meta-Analysis and Network Meta-Analysis from 55 Randomized Controlled Trials. Nutrients. 2020; 12(10):3203. https://doi.org/10.3390/nu12103203

Chicago/Turabian Style

Kim, Jeongseon, Tung Hoang, Ji-Myung Kim, So Young Bu, Jeong-Hwa Choi, Eunju Park, Seung-Min Lee, Eunmi Park, Ji Yeon Min, In Seok Lee, and et al. 2020. "All-Cause Mortality and Cardiovascular Death between Statins and Omega-3 Supplementation: A Meta-Analysis and Network Meta-Analysis from 55 Randomized Controlled Trials" Nutrients 12, no. 10: 3203. https://doi.org/10.3390/nu12103203

APA Style

Kim, J., Hoang, T., Kim, J.-M., Bu, S. Y., Choi, J.-H., Park, E., Lee, S.-M., Park, E., Min, J. Y., Lee, I. S., Youn, S. Y., & Yeon, J.-Y. (2020). All-Cause Mortality and Cardiovascular Death between Statins and Omega-3 Supplementation: A Meta-Analysis and Network Meta-Analysis from 55 Randomized Controlled Trials. Nutrients, 12(10), 3203. https://doi.org/10.3390/nu12103203

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