Marco Lombardi1,2, Juan G Chiabrando3,4, Giovanni M Vescovo5, Edoardo Bressi1,6, Marco Giuseppe Del Buono1,2, Salvatore Carbone1,7, Rachel A Koenig8, Benjamin W Van Tassell1,9, Antonio Abbate1, Giuseppe Biondi-Zoccai10,11, Dave L Dixon12,13. 1. VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA. 2. Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy. 3. Interventional Cardiology Service, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina. 4. Health Science Statistics Applied Laboratory (LEACS), Pharmacology and Toxicology Department, School of Medicine, University of Buenos Aires, Buenos Aires, Argentina. 5. Department of Cardiac Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy. 6. Division of Cardiology, Policlinico Casilino, Rome, Italy. 7. Department of Kinesiology & Health Sciences, College of Humanities & Sciences, Virginia Commonwealth University, Richmond, VA, USA. 8. Tompkins-McCaw Library for the Health Sciences, VCU Libraries Virginia Commonwealth University, Richmond, VA, USA. 9. Department of Pharmacotherapy & Outcomes Science, Virginia Commonwealth University, Richmond, VA, USA. 10. Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy. 11. Mediterranea Cardiocentro, Napoli, Italy. 12. VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA. dldixon@vcu.edu. 13. Department of Pharmacotherapy & Outcomes Science, Virginia Commonwealth University, Richmond, VA, USA. dldixon@vcu.edu.
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). HD O3FA treatment was associated with lower cardiovascular events compared to LD and to control, but increased risk for bleeding and atrial fibrillation events.
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). HDO3FA treatment was associated with lower cardiovascular events compared to LD and to control, but increased risk for bleeding and atrial fibrillation events.
Authors: Marco Lombardi; Salvatore Carbone; Marco Giuseppe Del Buono; Juan Guido Chiabrando; Giovanni Maria Vescovo; Massimiliano Camilli; Rocco Antonio Montone; Rocco Vergallo; Antonio Abbate; Giuseppe Biondi-Zoccai; Dave L Dixon; Filippo Crea Journal: Eur Heart J Cardiovasc Pharmacother Date: 2021-07-23