A Meta-analysis of Randomized Trials of Fish Oil in Prevention of Restenosis Following Coronary Angioplasty

O’Connor, Gerald T.; Malenka, David J.; Olmstead, Elaine M.; Johnson, Patricia S.; Hennekens, Charles H.

doi:10.1016/s0749-3797(18)30830-4

Cited by 44 publications

(16 citation statements)

References 26 publications

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“…In the studies on restenosis after angioplasty, undoubtedly consisting of patient populations with a mixed type of atherogenesis-promoting factors, firm conclusion as to the effectiveness of fish oil can not be drawn because there is not (yet) a unidirectional trend. We agree with others [96] that a large trial evaluating the effect of fish oil on restenosis in angioplasty patients by coronary angiography may provide an answer. We also believe that it is time to reach a consensus as to which animal models mimic most closely a particular human situalion.…”

Section: Discussionsupporting

confidence: 89%

“…Coronary angiography was conducted in almost all patients in four studies [87,88,91,93] and selectively in four [89,90,92,94], while in the study by Slack et al [86] only exercise tests were evaluated. O'Connor and colleagues have recently performed a meta-analysis of seven [86][87][88][89][90][91]94] studies (see also Table 6) [96] and concluded that fish oil yields a small to moderate reduction in restenosis rate (6-46%). The large range was due to the small sample size of the studies (82-194 patients) and therefore only a randomized clinical trial involving over 880 patients can reliably answer the question whether fish oil is effective as a non-pharmacological adjuvant in the prevention of restenosis.…”

Section: Restenosis After Percutaneous Transluminal Coronary Angioplamentioning

confidence: 99%

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Fish oil and the prevention and regression of atherosclerosis

Sassen

Lamers

Verdouw

1994

Cardiovasc Drug Ther

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Summary. Epidemiological studies in the seventies have put forward that dietary rather than genetic factors are responsible for the lower incidence of ischemic heart disease in Greenland Inuit and have generated a large body of both in vitro and in vivo experimental studies, exploring the putative favorable effects of fish (oil) on atherogenesis and its risk factors. The first part of this report reviews the in vivo animal studies, concentrating on the hypercholesterolemic models and the arterialized vein graft model. In the hypercholesterolemic animal studies, the results are inconclusive as the studies reporting a protective effect are matched by the number of studies showing no effect or an adverse effect. The diversity in species, dose of fish oil, duration of study, type of vessel studied and type of fish oil preparation (content of n-3 fatty acids, unesterified n-3 fatty acids, ethylesters or triglyceridcs) could all contribute. Furthermore, the definitions and criteria used in the literature to evaluate atherogenesis are diverse and it appears that while one parameter is affected, another is not necessarily modified in the same direction, stressing the importance of extending the analysis of the effects on atherogenesis to more than one parameter. We also believe that it is time to reach a consensus as to which animal model mimicks most closely a particular human situation. Only in appropriate models, investigating more than one atherosclerosis variable, can the effects of a putative anti-atherogenic drug or diet be verified. In the veno-arterial autograft model, mimicking the patient after coronary bypass grafting, dietary fish oil has been consistently effective in preventing accelerated graft intima proliferation. It could therefore be of interest to evaluate the effects of fish oil on graft patency in patients after coronary bypass surgery after a period of years.The results from studies on restenosis after percutaneous transluminal angioplasty are also reviewed and it is concluded that the two large scale trials, that are currently underway, might reliably answer the question whether fish oil is effective as a non-pharmacological adjuvants in the prevention of restenosis.Lastly, the studies on the effects of fish oil on the regression of experimental atherosclerosis are reviewed. In view of the small number of studies (i.e., four) investigating the effects of fish oil on the regression of atherosclerosis, it is premature to draw any conclusion, and therefore further experimental work is required.

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Section: Discussionsupporting

confidence: 89%

Section: Restenosis After Percutaneous Transluminal Coronary Angioplamentioning

confidence: 99%

Fish oil and the prevention and regression of atherosclerosis

Sassen

Lamers

Verdouw

1994

Cardiovasc Drug Ther

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“…For example in the MRFIT intervention trial13 in which, being a large trial, there were over 1000 deaths the ratio of neoplastic deaths was 140 intervention, 149 control. Summarising an analysis of 26 randomised trials of cholesterol reduction (50,000 patients, details not provided), apparently mostly drug trials, M~M a h o n~~ found the relative risk of cancer death among those assigned cholesterol-lowering treatments was 1.1 k 0.1 and for -trauma death 1.3 t-0.2. D01ecek~~ has examined the relationship between disease incidence and polyunsaturated fat intake, 18:2 n-6 and 18:3 n-3 and fish n-3s from four dietary recalls in the large MRFIT intervention trial.…”

Section: Selections From the Full Set Of Major Dietary Trialsmentioning

confidence: 99%

Review of dietary intervention studies: effect on coronary events and on total mortality

1994

Australian and New Zealand Journal of Medicine

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“…Three meta-analyses performed to examine these studies concluded that fish oils do prevent restenosis. [14][15][16] However, the most recently published meta-analysis was only able to document clinically important benefits in 5 of 12 studies. 15 A 13th study was excluded due to high fish oil intake.…”

Section: Fish Oils In Disease Preventionmentioning

confidence: 99%

Are dietary recommendations for the use of fish oils sustainable?

Jenkins¹,

Sievenpiper²,

Pauly³

et al. 2009

Canadian Medical Association Journal

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Contributors:David Jenkins had the original idea for the commentary and drafted the manuscript. John Sievenpiper gathered the references, produced the figure and helped draft the manuscript. Daniel Pauly and Ussif Rashid Sumaila drafted the sections on the decline of fisheries, socio-economic effects and aquaculture, and revised significant intellectual content related to the other sections. Cyril Kendall and Farley Mowat revised significant intellectual content. All of the authors approved the final manuscript submitted for publication.

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A Meta-analysis of Randomized Trials of Fish Oil in Prevention of Restenosis Following Coronary Angioplasty

Cited by 44 publications

References 26 publications

Fish oil and the prevention and regression of atherosclerosis

Fish oil and the prevention and regression of atherosclerosis

Review of dietary intervention studies: effect on coronary events and on total mortality

Are dietary recommendations for the use of fish oils sustainable?

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