Lack of benefit of dietary advice to men with angina: results of a controlled trial

Abstract

Objective: To see whether mortality among men with angina can be reduced by dietary advice. Design: A randomized controlled factorial trial. Setting: Male patients of general practitioners in south Wales. Subjects: A total of 3114 men under 70 y of age with angina. Interventions: Subjects were randomly allocated to four groups: (1) advised to eat two portions of oily fish each week, or to take three fish oil capsules daily; (2) advised to eat more fruit, vegetables and oats; (3) given both the above types of advice; and (4) given no specific dietary advice. Mortality was ascertained after 3 -9 y. Results: Compliance was better with the fish advice than with the fruit advice. All-cause mortality was not reduced by either form of advice, and no other effects were attributable to fruit advice. Risk of cardiac death was higher among subjects advised to take oily fish than among those not so advised; the adjusted hazard ratio was 1.26 (95% confidence interval 1.00, 1.58; P ¼ 0.047), and even greater for sudden cardiac death (1.54; 95% CI 1.06, 2.23; P ¼ 0.025). The excess risk was largely located among the subgroup given fish oil capsules. There was no evidence that it was due to interactions with medication. Conclusions: Advice to eat more fruit was poorly complied with and had no detectable effect on mortality. Men advised to eat oily fish, and particularly those supplied with fish oil capsules, had a higher risk of cardiac death. This result is unexplained; it may arise from risk compensation or some other effect on patients' or doctors' behaviour.

Dietary fatty acids and cardiovascular disease

“…They also failed to distinguish any specific effects of consuming oily fish or fish oil supplements. The outcome of this analysis has sparked considerable debate, especially the concern regarding the inclusion of the Diet and Angina Randomized Trial (DART-2) by Burr et al (2003), which reported adverse effects of increasing oily fish consumption/fish oil supplements in patients suffering from angina. This trial has been criticized as being unblinded and for the nature of the EPA-rich fish oil (Marik and Varon, 2009).…”

Omega-3 fatty acids and cardiovascular disease: A case for omega-3 index as a new risk factor

“…• prospective cohorts -Yes [34,[51][52][53][54][55][56][57][58][59][60][61]; No [62] • case-control studies -Yes [63,64]; No [62,65] • Raising biomarker levels with fish or omega-3 FAs reduces risk -Yes [66,67]; No [68] • Strong association between biomarker and disease -Yes [34] • Biomarker independent of other known risk factors -Yes [33,34,59] • Adds predictive value to currently-available risk markers -Unknown …”

Meta-analysis of the effects of n-3 polyunsaturated fatty acids on lipoproteins and other emerging lipid cardiovascular risk markers in patients with type 2 diabetes

“…of cardiovascular mortality in high-risk and general populations [1], although recent trials [2,3] and a metaanalysis [4] have cast doubt on the strength of this evidence. There are limited data about the potential benefits for people with type 2 diabetes [5,6], but two prospective cohort studies among women showed that the risk of coronary heart disease is much lower among women with type 2 diabetes who consume n-3 PUFA [5,7].…”