Positive Health Online

Abstract

ALEXANDER and COLLEAGUES, 1. Department of Epidemiology, EpidStat Institute, Ann Arbor, MI. Electronic address: dalexander@epidstat.com ; 2. Nutrition and Food Services, Edward Hines Jr VA Hospital, Hines, IL; 3. Scientific and Regulatory Affairs, Van Elswyk Consulting, Inc, Longmont, CO; 4. Scientific Affairs, Kuratko Nutrition Research, Ellicott City, MD; 5. Department of Epidemiology, EpidStat Institute, Ann Arbor, MI. ; Comment in •Prescribing More Stringent Design of Randomized Clinical Trials of Omega-3 Polyunsaturated Fatty Acids. [Mayo Clin Proc. 2017]; • In Reply I-Prescribing More Stringent Design of Randomized Clinical Trials of Omega-3 Polyunsaturated Fatty Acids. [Mayo Clin Proc. 2017] conducted a meta-analysis of randomized controlled trials (RCTs) to study the effect of eicosapentaenoic and docosahexaenoic acid (EPA+DHA) on coronary heart disease (CHD).

Background

The authors set out to conduct meta-analyses of randomized controlled trials (RCTs) to estimate the effect of eicosapentaenoic and docosahexaenoic acid (EPA+DHA) on coronary heart disease (CHD), and to conduct meta-analyses of prospective cohort studies to estimate the association between EPA+DHA intake and CHD risk.

Methodology

A systematic literature search of Ovid/Medline, PubMed, Embase, and the Cochrane Library from January 1, 1947, to November 2, 2015, was conducted; 18 RCTs and 16 prospective cohort studies examining EPA+DHA from foods or supplements and CHD, including myocardial infarction, sudden cardiac death, coronary death, and angina, were identified. Random-effects meta-analysis models were used to generate summary relative risk estimates (SRREs) and 95% CIs. Heterogeneity was examined in subgroup and sensitivity analyses and by meta-regression. Dose-response was evaluated in stratified dose or intake analyses. Publication bias assessments were performed.

Results

Among RCTs, there was a non-statistically significant reduction in CHD risk with EPA+DHA provision (SRRE=0.94; 95% CI, 0.85-1.05). Subgroup analyses of data from RCTs indicated a statistically significant CHD risk reduction with EPA+DHA provision among higher-risk populations, including participants with elevated triglyceride levels (SRRE=0.84; 95% CI, 0.72-0.98) and elevated low-density lipoprotein cholesterol (SRRE=0.86; 95% CI, 0.76-0.98). Meta-analysis of data from prospective cohort studies resulted in a statistically significant SRRE of 0.82 (95% CI, 0.74-0.92) for higher intakes of EPA+DHA and risk of any CHD event.

Conclusion

Results indicate that EPA+DHA may be associated with reducing CHD risk, with a greater benefit observed among higher-risk populations in RCTs.

References

Alexander DD1, Miller PE2, Van Elswyk ME3, Kuratko CN4, Bylsma LC5. Eicosapentaenoic and Docosahexaenoic Long-Chain Omega-3 Fatty Acids and Coronary Heart Disease Risk. A Meta-Analysis of Randomized Controlled Trials and Prospective Cohort Studies of Author information: Mayo Clin Proc.;92(1):15-29. doi: 10.1016/j.mayocp.2016.10.018. Jan 2017.