Effects of n-3 Fatty Acid Supplements in Elderly Patients After Myocardial Infarction

Abstract

Background: High intake of marine n-3 polyunsaturated fatty acids (PUFA) has been associated with reduced risk of cardiovascular events; however, this has not been confirmed in patients with a recent acute myocardial infarction (AMI). Elderly patients are at particularly increased cardiovascular risk after MI, but few trials address this group specifically. Omega-3 fatty acids hold the potential to reduce cardiovascular events with limited adverse effects in this vulnerable group. The hypothesis was that daily addition of 1.8g n-3 PUFA to standard of care secondary prophylaxis in elderly patients who have survived an AMI would reduce the risk of subsequent cardiovascular events during 2 years follow-up. Methods: The OMega-3 fatty acids in Elderly with Myocardial Infarction (OMEMI) trial is an investigator-initiated, multi-center, randomized clinical trial adding 1.8 g n-3 PUFA (930 mg EPA and 660 mg DHA) versus placebo (corn oil) daily to standard of care in 70-82 years old patients with recent (2-8 weeks) AMI. The primary endpoint was a composite of non-fatal AMI, unscheduled revascularization, stroke, all-cause death, heart failure hospitalization after two years. The secondary outcome was new atrial fibrillation. The safety outcome was major bleeding. Serum fatty acids were measured as biomarkers of adherence. Results: In total, 1,027 patients were randomized. Follow-up data were available for 1,014 patients who were included in the intention-to-treat analysis. Mean ± SD age was 75±3.6 years, 294 (29%) were female and mean triglycerides were 111.4±61.9 mg/dL. The primary endpoint occurred in 108 (21.4%) patients on n-3 PUFA vs 102 (20.0%) on placebo (HR 1.08 [95%CI 0.82-1.41], p=0.60). The secondary endpoint occurred in 28 (7.2%) patients on n-3 PUFA vs 15 (4.0%) on placebo (1.84 [0.98 -3.45], p=0.06). Median changes in EPA and DHA were +87% and +16% for n-3 PUFA vs -13% and -8% for placebo. Major bleeding occurred in 54 (10.7%) and 56 (11.0%) in the n-3 PUFA and placebo groups, respectively (p=0.87). Similar results were found in per-protocol analysis (n=893). Conclusions: We could not detect reduction in clinical events in our elderly patients with a recent AMI, treated with 1.8 g n-3 PUFAs daily for 2 years. Clinical Trial Registration: OMEMI Study; URL: https://clinicaltrials.gov Unique Identifier: NCT01841944

Relationship between serum angiopoietin-like 4 levels and recurrence of atrial fibrillation

“…Additionally, the risk of AF was not reduced or even increased by ω-3 PUFA treatment in two recently published reports. 16 , 17 Therefore, the mechanism of action of ω-3 PUFAs is complex, and pathological factors (e.g., increased risk of bleeding) and protective factors exist simultaneously. Our study showed reduced serum ANGPTL4 levels in patients with AF compared with healthy controls.…”

An Update on Omega-3 Polyunsaturated Fatty Acids and Cardiovascular Health

“…Two Ω-3 trials were released in late 2020, which did not find any CV benefits of Ω-3 therapy in high-risk patients. OMEMI used a lower-dose intervention (1.8 g/day EPA + DHA in addition to standard medical care) in elderly patients (age 70–82) following acute MI (2–8 weeks) [ 49 ]. There was no statistically significant difference in outcomes between treatment and placebo groups, which may be explained by insufficient Ω-3 dosing.…”

Microalgae n-3 PUFAs Production and Use in Food and Feed Industries

“…EPA and DHA used individually (5 g × day −1 ) seemed to diminish infarct size, while a combination of both to a level of 5 g × kg −1 did not [ 23 ]. Supplementation of EPA+DHA to a level of 1.8 g/day −1 for elderly patients with a recent acute myocardial infarction did not reduce clinical events either [ 24 ]. This might be due to n-3 PUFAs’ competition for the same receptors or biased signaling as observed with some protein receptors [ 23 ].…”