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Impact of Different Doses of Omega-3 Fatty Acids on Cardiovascular Outcomes: a Pairwise and Network Meta-analysis

  • Evidence-Based Medicine, Clinical Trials and Their Interpretations (L. Roever,Section Editor)
  • Published:
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Abstract

Purpose of Review

Omega-3 fatty acid (O3FA) supplementation has shown conflicting evidence regarding its benefit in cardiovascular events. We performed a pairwise and network meta-analysis to elucidate the benefit of different doses of O3FA supplementation in cardiovascular prevention.

Recent Findings

Fourteen studies were identified providing data on 125,763 patients. A prespecified cut-off value of < 1 g per day was set for low-dose (LD) O3FA and > 1 g per day for high-dose (HD) O3FA. The efficacy outcomes of interest were total death, cardiac death, sudden cardiac death, myocardial infarction, stroke, coronary revascularization, unstable angina, and major vascular events. Safety outcomes of interest were bleeding, gastrointestinal disturbances, and atrial fibrillation events. HD treatment was associated with a lower risk of cardiac death (IRR 0.79, 95% CI [0.65–0.96], p = 0.03 versus control), myocardial infarction (0.71 [0.62–0.82], p < 0.0001 versus control and 0.79 [0.67–0.92], p = 0.003 versus LD), coronary revascularization (0.74 [0.66–0.83], p < 0.0001 versus control and 0.74 [0.66–0.84], p < 0.0001 versus LD), unstable angina (0.73 [0.62–0.86], p = 0.0001 versus control and 0.74 [0.62–0.89], p = 0.002 versus LD), and major vascular events (0.78 [0.71–0.85], p < 0.0001 versus control and 0.79 [0.72–0.88], p < 0.0001 versus LD). HD treatment was associated with increased risk for bleeding events (1.49 [1.2–1.84], p = 0.0002 versus control and 1.63 [1.16–2.3], p = 0.005 versus LD) and increased atrial fibrillation events compared to control (1.35 [1.1–1.66], p = 0.004).

Summary

HD O3FA treatment was associated with lower cardiovascular events compared to LD and to control, but increased risk for bleeding and atrial fibrillation events.

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Abbreviations

CENTRAL:

Cochrane Central Register of Controlled Trials

95% CI:

95% Confidence interval

CVD:

Cardiovascular disease

DHA:

Docosahexaenoic acid

EPA:

Eicosapentaenoic acid

FDA:

Food and Drug Administration

HD:

High dose

HDL-C:

High-density lipoprotein cholesterol

IQR:

Interquartile range

IRR:

Incidence rate ratio

LD:

Low dose

LDL-C:

Low-density lipoprotein cholesterol

O3FA:

Omega-3 fatty acids

PCSK9:

Proprotein convertase subtilisin-kexin type 9

PRISMA:

Preferred Reporting Items for Systematic Reviews and Meta-analysis

RCT:

Randomized clinical trial

TG:

Triglyceride

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Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Author information

Authors and Affiliations

  1. VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA

    Marco Lombardi, Edoardo Bressi, Marco Giuseppe Del Buono, Salvatore Carbone, Benjamin W. Van Tassell, Antonio Abbate & Dave L. Dixon

  2. Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy

    Marco Lombardi & Marco Giuseppe Del Buono

  3. Interventional Cardiology Service, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina

    Juan G. Chiabrando

  4. Health Science Statistics Applied Laboratory (LEACS), Pharmacology and Toxicology Department, School of Medicine, University of Buenos Aires, Buenos Aires, Argentina

    Juan G. Chiabrando

  5. Department of Cardiac Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy

    Giovanni M. Vescovo

  6. Division of Cardiology, Policlinico Casilino, Rome, Italy

    Edoardo Bressi

  7. Department of Kinesiology & Health Sciences, College of Humanities & Sciences, Virginia Commonwealth University, Richmond, VA, USA

    Salvatore Carbone

  8. Tompkins-McCaw Library for the Health Sciences, VCU Libraries Virginia Commonwealth University, Richmond, VA, USA

    Rachel A. Koenig

  9. Department of Pharmacotherapy & Outcomes Science, Virginia Commonwealth University, Richmond, VA, USA

    Benjamin W. Van Tassell & Dave L. Dixon

  10. Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy

    Giuseppe Biondi-Zoccai

  11. Mediterranea Cardiocentro, Napoli, Italy

    Giuseppe Biondi-Zoccai

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Contributions

All authors contributed to the conception or design of the work. ML, JGC, GMV, EB, MDB contributed to the acquisition, analysis, or interpretation of data for the work; RK contributed to the acquisition of the data, CS, BVT, DLD contributed to interpretation of the data, AA and GBZ contributed to analysis and interpretation of the data. ML, JGC, GMV, EB, MDB drafted the manuscript. CS, BVT, DLD, AA, GBZ critically revised the manuscript. All authors gave final approval and agree to be accountable for all aspects of work ensuring integrity and accuracy.

All authors confirm that tables and figures were not published previously.

Corresponding author

Correspondence to Dave L. Dixon.

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Conflict of Interest

None of the authors have any disclosure related to the contents of this paper. Salvatore Carbone is supported by a Career Development Award 19CDA34660318 from the American Heart Association. Marco Lombardi, Juan G. Chiabrando, Giovanni M. Vescovo, Edoardo Bressi, Marco Giuseppe Del Buono, Salvatore Carbone, Rachel Koenig, Benjamin W. Van Tassell, Dave L. Dixon, Antonio Abbate, and Giuseppe Biondi-Zoccai declare they have no conflict of interest.

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Lombardi, M., Chiabrando, J.G., Vescovo, G.M. et al. Impact of Different Doses of Omega-3 Fatty Acids on Cardiovascular Outcomes: a Pairwise and Network Meta-analysis. Curr Atheroscler Rep 22, 45 (2020). https://doi.org/10.1007/s11883-020-00865-5

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