In omega-3 fatty acid trials, EPA alone yields greater CV risk reduction vs. EPA plus DHA
In a meta-analysis of omega-3 fatty acid trials, eicosapentaenoic acid monotherapy yielded the greatest reduction in CV risk vs. a combination of eicosapentaenoic acid and docosahexaenoic acid.
“In this systematic review and meta-analysis, we noted moderate certainty of evidence favoring omega-3 fatty acids for reducing CV mortality and outcomes,” Cardiology Today Intervention Section Editor Deepak L. Bhatt, MD, MPH, executive director of interventional cardiovascular programs at the Brigham and Women’s Hospital and professor of medicine at Harvard Medical School, and colleagues wrote in eClinical Medicine. “The magnitude of relative reductions was robust in eicosapentaenoic acid (EPA) trials vs. those of eicosapentaenoic acid/docosahexaenoic acid (DHA), suggesting differential effects of EPA and DHA in cardiovascular risk reduction.”
Bhatt and colleagues analyzed the effectiveness of omega-3 fatty acids on CV outcomes while examining the variability in EPA compared with a combination of EPA and DHA. The researchers evaluated CV mortality, nonfatal CV outcomes, bleeding and atrial fibrillation in a meta-analysis of 38 randomized clinical trials of omega-3 fatty acids, categorized by EPA monotherapy or EPA/DHA therapy.
The clinical trials analyzed were published before June 7, 2021. In 149,051 individuals who participated in the 38 trials, omega-3 fatty acid use correlated with reduced risk for CV mortality (RR = 0.93; 95% CI, 0.88-0.98), nonfatal MI (RR = 0.87; 95% CI, 0.81-0.93), CHD events (RR = 0.91; 95% CI, 0.87-0.96), major adverse CV events (RR = 0.95; 95% CI, 0.92-0.98) and revascularization (RR = 0.91; 95% CI, 0.87-0.95).
Bhatt and colleagues observed higher risk reductions with EPA monotherapy than with EPA/DHA for CV mortality, nonfatal MI, CHD events, major adverse CV events and revascularization.
However, the monotherapy was associated with higher risk for total bleeding (RR = 1.49; 95% CI, 1.2-1.84) and AF (RR = 1.35; 95% CI, 1.1-1.66), according to the researchers. Yet, EPA monotherapy also correlated with a reduction in nonfatal stroke.
“This meta-analysis provides reassurance about the role of omega-3 fatty acids, specifically prescription EPA,” Bhatt said in a press release. “It should encourage investigators to explore further the CV effects of EPA across different clinical settings.”