Effect of Omega-3 Dosage on Cardiovascular Outcomes

Abstract

Objectives: To quantify the effect of eicosapentaenoic (EPA) and docosahexaenoic (DHA) acids on cardiovascular disease (CVD) prevention and the effect of dosage. Methods: This study is designed as a random effects meta-analysis and meta-regression of randomized control trials with EPA/DHA supplementation. This is an update and expanded analysis of a previously published meta-analysis which covers all randomized control trials with EPA/DHA interventions and cardiovascular outcomes published before August 2019. The outcomes included are myocardial infarction (MI), coronary heart disease (CHD) events, CVD events (a composite of MI, angina, stroke, heart failure, peripheral arterial disease, sudden death, and non-scheduled cardiovascular surgical interventions), CHD mortality and fatal MI. The strength of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation framework. Results: A total of 40 studies with a combined 135,267 participants were included. Supplementation was associated with reduced risk of MI (relative risk [RR], 0.87; 95% CI, 0.80 to 0.96), high certainty number needed to treat (NNT) of 272; CHD events (RR, 0.90; 95% CI, 0.84 to 0.97), high certainty NNT of 192; fatal MI (RR, 0.65; 95% CI, 0.46 to 0.91]), moderate certainty NNT ¼ 128; and CHD mortality (RR, 0.91; 95% CI, 0.85 to 0.98), low certainty NNT ¼ 431, but not CVD events (RR, 0.95; 95% CI, 0.90 to 1.00). The effect is dose dependent for CVD events and MI. Conclusion: Cardiovascular disease remains the leading cause of death worldwide. Supplementation with EPA and DHA is an effective lifestyle strategy for CVD prevention, and the protective effect probably increases with dosage.

Saving the planet with appropriate biotechnology: 3. The high seas solution

“…Apart from the good amino acid profile of their constituent proteins (concentrated in fishmeal after the fish is processed) and their content of vitamins, minerals and trace elements, marine foods are healthy nutritional sources because, they contain high levels of long chain omega-3 polyunsaturated fatty acids (LC-PUFA, which is concentrated in fish oil after the fish is processed). Many research findings have demonstrated the value of omega-3 fatty acids in human nutrition (Bernasconi et al, 2020). LC-PUFA are known to lower blood pressure, slow the development of arterial plaque, reduce the chance of abnormal heart rhythm and the likelihood of heart attack and stroke.…”

“…Consequently, the benefit to the human heart, eyes and brain is important enough for us to need to obtain LC-PUFA in sufficient quantities from our nutrition for healthy growth and development. It thus becomes quite critical to preserve farmed fish as a good LC-PUFA omega-3 source, particularly since a recent study has shown that the more LC-PUFA you ingest, the better your body feels (Bernasconi et al, 2020).…”

In Reply–Impact of a High-Shrimp Diet on Cardiovascular Risk

“…To The Editor: We greatly appreciate the interest by Narasimhan and colleagues in the recent major metaanalysis by Bernasconi et al 1 In this article, we analyzed 40 studies, including more than 135,000 participants, and demonstrated that omega-3 therapy was associated with major reductions in fatal myocardial infarction (MI); (e35%), total MI (e13%), coronary heart disease (CHD) events (e10%), and CHD mortality (e9%). We further demonstrated a strong dosage effect in which higher doses of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) were associated with fewer cardiovascular disease (CVD) outcomes.…”

“…For the majority of people who do not consume adequate omega-3 from dietary sources, especially for those with known CVD or high risk of CVD, our recent study strongly suggests that clinicians should recommend omega-3 therapy containing EPA and DHA to reduce major CVD outcomes. 1,2 The…”

Untitled

“…Whereby, in the REDUCE-IT trial Icosapent ethyl (IPE), a highly purified form of eicosapentaenoic acid (EPA) ethyl ester, added to a statin reduced initial cardiovascular (CV) events by 25% and total CV events by 32 [11]. The recently concluded EVAPORATE study demonstrated that administration of IPE together with statin led to increased regression of low-attenuation plaque volume on multidetector computed tomography compared with placebo over 18 months [12] Furthermore, meta-analysis and meta-regression of interventional trials provides additional support for the use of enriched omega-3 FAs, EPA and docosahexaenoic acid (DHA) as an effective strategy for CVD prevention [13]. Of note, the utility of omega-3 supplements does not appear to be universal, with several studies suggesting that some omega-3 supplements display limited benefit in reducing inflammation [14][15][16].…”