N-3 polyunsaturated fatty acids in coronary heart disease: a meta-analysis of randomized controlled trials

Bucher, Heiner C.; Hengstler, Peter; Schindler, Christian; Meier, Gabriela

doi:10.1016/s0002-9343(01)01114-7

Cited by 710 publications

(450 citation statements)

References 42 publications

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“…Our results are consistent with previous systematic reviews in patients with type 2 diabetes [9,56,57] and in the general population [1,15], showing that TG levels fall significantly after n-3 PUFA supplementation. After adjusting for HDL, increasing levels of TG have been shown to be an independent risk factor for cardiovascular disease in epidemiological studies [60], so lowering of TG levels may be an important therapeutic effect of n-3 PUFA supplementation in patients with type 2 diabetes.…”

Section: Discussionsupporting

confidence: 93%

“…After adjusting for HDL, increasing levels of TG have been shown to be an independent risk factor for cardiovascular disease in epidemiological studies [60], so lowering of TG levels may be an important therapeutic effect of n-3 PUFA supplementation in patients with type 2 diabetes. TC levels were non-significantly lowered, similar to results of previous systematic reviews in type 2 diabetes [9,56,57] and in the general population [1], but were reduced in hypertriacylglycerolaemic patients [11]. HDL was non-significantly increased, as shown in previous systematic reviews of type 2 diabetes [9,56,57], in the general population and in type IIa hypercholesterolaemia patients [15].…”

Section: Discussionsupporting

confidence: 87%

“…A fourth systematic review considered the effects of n-3 PUFA on TG, HDL, VLDL and LDL-cholesterol [11] in ten trials including 606 patients with hypertriacylglycerolaemia, but not type 2 diabetes. Three other systematic reviews of effects of n-3 PUFA in the general population [1,15,58] considered mortality as their main endpoint but also reported lipid markers. One further systematic review Fewer than two trials reported the outcome Change data not reported RCTs withdrawn by pooled outcome due to missing data:…”

Section: Discussionmentioning

confidence: 99%

“…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].…”

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confidence: 99%

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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

et al. 2007

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Aims/hypothesis To determine the effects of marine-derived n-3 polyunsaturated fatty acids (PUFA) on established and emerging lipid and lipoprotein cardiovascular risk markers in patients with type 2 diabetes. Materials and methods We performed a systematic review and meta-analysis of randomised controlled trials comparing dietary or non-dietary intake of n-3 PUFA with placebo in patients with type 2 diabetes by searching databases from 1966 to December 2006. Changes in the following variables were recorded triacylglycerol; total cholesterol; HDL, LDL and VLDL and their subfractions; lipid ratios; apolipoproteins; and cholesterol particle sizes. Results There were 23 trials on non-dietary supplementation, involving 1,075 subjects with a mean treatment duration of 8.9 weeks, with sufficient data to permit pooling. Compared with placebo, n-3 PUFA had a statistically significant effect on four outcomes, reducing levels of (1) triacylglycerol (18 trials, 969 subjects) by 25% (mean 0.45 mmol/l; 95% CI −0.58 to −0.32; p<0.00001); (2) VLDL-cholesterol (7 trials, 238 subjects) by 36% (0.07 mmol/l; 95% CI −0.13 to 0.00; p=0.04); and (3) VLDL-triacylglycerol (6 trials, 178 subjects) by 39.7% (0.44 mmol/l; 95% CI −0.83 to −0.05; p= 0.03); while slightly increasing LDL (16 trials, 565 subjects) by 5.7% (0.11 mmol/l; 95% CI 0.00 to 0.22; p=0.05). There were no significant effects on total cholesterol, apolipoproteins, lipid subfractions or ratios. Conclusions/interpretation In addition to recognised triacylglycerol-lowering effects, n-3 PUFA supplementation decreases VLDL-cholesterol and VLDL-triacylglycerol, but may have an adverse effect on LDL-cholesterol. Larger and longer term clinical trials are required to conclusively establish the effect of n-3 PUFA on cardiovascular risk markers and outcomes in type 2 diabetic patients.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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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

et al. 2007

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“…Fish oil contains the very long-chain n-3 PUFA EPA and DHA. There is strong evidence for health benefits of these fatty acids, especially with regard to CVD (33)(34)(35)(36) . They act to modify tissue and blood lipid metabolism, blood lipid concentrations, blood coagulation, immune function, inflammation and endothelial function (37)(38)(39)(40)(41) .…”

Section: Desirable Properties For Lipids To Be Used In Artificial Nutmentioning

confidence: 99%

Rationale and use of n-3 fatty acids in artificial nutrition

Calder

2010

Proc. Nutr. Soc.

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Lipids traditionally used in artificial nutrition are based on n-6 fatty acid-rich vegetable oils like soyabean oil. This may not be optimal because it may present an excessive supply of linoleic acid. One alternative to the use of soyabean oil is its partial replacement by fish oil, which contains n-3 fatty acids. These fatty acids influence inflammatory and immune responses and so may be useful in particular situations where those responses are not optimal. Fish oil-containing lipid emulsions have been used in parenteral nutrition in adult patients post-surgery (mainly gastrointestinal). This has been associated with alterations in patterns of inflammatory mediators and in immune function and, in some studies, a reduction in length of intensive care unit (ICU) and hospital stay. Perioperative administration of fish oil may be superior to post-operative. Parenteral fish oil has been used in critically ill adults. Here the influence on inflammatory processes, immune function and clinical endpoints is not clear, since there are too few studies and those that are available report contradictory findings. Fish oil is included in combination with other nutrients in various enteral formulas. In post-surgical patients and in those with mild sepsis or trauma, there is clinical benefit from a formula including fish oil and arginine. A formula including fish oil, borage oil and antioxidants has demonstrated marked benefits on gas exchange, ventilation requirement, new organ failures, ICU stay and mortality in patients with acute respiratory distress syndrome, acute lung injury or severe sepsis.

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Association Between Omega-3 Fatty Acid Supplementation and Risk of Major Cardiovascular Disease Events

Rizos¹,

Ntzani²,

Bika³

et al. 2012

JAMA

889

554

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Context Considerable controversy exists regarding the association of omega-3 polyunsaturated fatty acids (PUFAs) and major cardiovascular end points.Objective To assess the role of omega-3 supplementation on major cardiovascular outcomes. Data Sources MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials through August 2012.Study Selection Randomized clinical trials evaluating the effect of omega-3 on allcause mortality, cardiac death, sudden death, myocardial infarction, and stroke.Data Extraction Descriptive and quantitative information was extracted; absolute and relative risk (RR) estimates were synthesized under a random-effects model. Heterogeneity was assessed using the Q statistic and I 2 . Subgroup analyses were performed for the presence of blinding, the prevention settings, and patients with implantable cardioverter-defibrillators, and meta-regression analyses were performed for the omega-3 dose. A statistical significance threshold of .0063 was assumed after adjustment for multiple comparisons. Data SynthesisOf the 3635 citations retrieved, 20 studies of 68 680 patients were included, reporting 7044 deaths, 3993 cardiac deaths, 1150 sudden deaths, 1837 myocardial infarctions, and 1490 strokes. No statistically significant association was observed with all-cause mortality (

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N-3 polyunsaturated fatty acids in coronary heart disease: a meta-analysis of randomized controlled trials

Cited by 710 publications

References 42 publications

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

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

Rationale and use of n-3 fatty acids in artificial nutrition

Association Between Omega-3 Fatty Acid Supplementation and Risk of Major Cardiovascular Disease Events

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