Source/Disclosures
Disclosures: The study was supported by a grant from GOED. Bernasconi is an employee of GOED. Lavie reports he was a speaker for Amarin, consulted for DSM Nutritional Products and made an educational video for and presented at a conference hosted by GOED. Please see the study for all other authors’ relevant financial disclosures.
October 02, 2020
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Omega-3 fatty acid supplementation may reduce risk for certain CVD outcomes

Source/Disclosures
Disclosures: The study was supported by a grant from GOED. Bernasconi is an employee of GOED. Lavie reports he was a speaker for Amarin, consulted for DSM Nutritional Products and made an educational video for and presented at a conference hosted by GOED. Please see the study for all other authors’ relevant financial disclosures.
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Supplementation with eicosapentaenoic acid and docosahexaenoic acid may reduce the risk for some CVD outcomes, including fatal MI and CHD events, researchers found.

Results of a meta-analysis published in Mayo Clinic Proceedings, which used data from a previously published meta-analysis, also found that the protective effect on MI and CVD events may increase with dosage of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) supplementation.

CV effects of EPA and DHA supplementation.
Carl J. Lavie

“We show a strong clinical benefit and a dosage effect,” Carl J. Lavie, MD, FACC, medical director of cardiac rehabilitation and prevention and director of exercise laboratories at John Ochsner Heart and Vascular Institute at the University of Queensland School of Medicine at Ochsner Clinical School – The University of Queensland School of Medicine in New Orleans, told Healio. “Additionally, our study did not find a significant impact of year of publication, meaning overall, the impact has been consistent over time. Finally, we did not find a significant effect of EPA dosage compared with combined EPA/DHA, realizing that only the REDUCE-IT and JELLIS [trials] were EPA alone.”

Effects of EPA/DHA on CVD outcomes

Aldo Bernasconi, PhD, vice president of data science for the Global Organization for EPA and DHA Omega-3s (GOED), and colleagues updated and expanded upon a previous comprehensive meta-analysis that was published in 2018 that included randomized controlled trials published before August 2019 that assessed the effect of EPA/DHA interventions on CVD outcomes. This current analysis included 135,267 patients from 40 studies.

Outcomes of interest in this analysis include CHD events, MI and CVD events, defined as a composite of angina, MI, HF, stroke, sudden death, peripheral artery disease and nonscheduled CV surgical outcomes. Researchers also examined CHD mortality and fatal MI.

Doses of EPA and DHA supplementation in these studies ranged from 400 mg per day to 5,500 mg per day, with an average dose of 1,221 mg per day.

Supplementation with EPA and DHA was associated with reduced risk for CHD events (RR = 0.9; 95% CI, 0.84-0.97; high certainty number needed to treat = 192), MI (RR = 0.87; 95% CI, 0.8-0.96; high certainty number needed to treat = 272), CHD mortality (RR = 0.91; 95% CI, 0.85-0.98; low certainty number needed to treat = 431) and fatal MI (RR = 0.65; 95% CI, 0.46-0.91; moderate certainty number needed to treat = 128). This was not observed for CVD events (RR = 0.95; 95% CI, 0.9-1).

This observed effect was dose dependent for MI and CVD events.

“Considering the low cost and side effect profile, as well as the lack of virtually any drug-drug interactions with virtually anything used in preventive cardiology, these strong benefits suggest that clinicians should be routinely recommending at least 1 g per day of EPA/DHA or preferably 1 g to 2 g at least in those who are not getting these high amounts through dietary sources (and few do) for primary and secondary prevention,” Lavie said in an interview.

Findings from other trials

Lavie told Healio that results from this study do not challenge findings from the REDUCE-IT trial. He said, “These results do not compete with the REDUCE-IT trial of patients with mostly hypertriglyceridemia with triglycerides in the low 200s mg/dL and mostly with ASCVD where prescription Vascepa (Amarin) or pure EPA at high doses (close to 4 g per day) produced tremendous benefits when added to statin therapy.”

For more information:

Carl J. Lavie, MD, FACC, can be reached at clavie@ochsner.org.