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Can Omega-3 Supplement Use Lower CVD Risk?

JAMA Cardiol; ePub 2018 Jan 31; Aung, et al

Use of marine-derived omega-3 fatty acid supplements has no significant association with fatal or nonfatal coronary heart disease (CHD) or any major vascular events, a recent study found. The meta-analysis provides no support for current recommendations for the use of omega-3 supplements in people with a history of CHD. It includes 77,917 high-risk individuals from 10 randomized trials; 47,803 (61.4%) were men, mean age at entry was 64.0 years, and the trials lasted a mean of 4.4 years. Researchers found:

  • The association of treatment with outcomes were assessed on 6,273 CHD events and 12,001 major vascular events.
  • Randomization to omega-3 fatty acid supplementation had no significant associations with CHD death (RR, 0.93), nonfatal myocardial infarction (RR, 0.97), or any CHD event (RR, 0.96).
  • Randomization to omega-3 fatty acid supplementation had no significant associations with any major vascular event (RR, 0.97), overall or in any subgroups.

Citation:

Aung T, Halsey J, Kromhout D, et al. Associations of omega-3 fatty acid supplement use with cardiovascular disease risks. Meta-analysis of 10 trials involving 77 917 individuals. [Published online ahead of print January 31, 2018]. JAMA Cardiol. doi:10.1001/jamacardio.2017.5205.

Commentary:

The use of omega-3 fatty acid supplementation (fish oil) captured the imagination of the public and physicians after observational trials showed that individuals who lived in countries where a lot of fish was eaten had a lower risk of heart disease.1 This led to randomized trials to look at whether the addition of fish oils was beneficial in decreasing heart disease in those with and without existing heart disease or at very high cardiovascular risk. Initially, the consumption of oily fish twice or more per week with CHD risk in men who had had a myocardial infarction was assessed and showed that fish consumption was associated with a reduction in fatal CHD and all-cause mortality.2 The addition of fish oils in capsule form was then assessed, and now with over 10 randomized trials, there are some trials that show positive results and some that have not. This past year, the American Heart Association recommendation said that the use of omega-3 fatty acids for prevention of CHD is probably justified in individuals with prior CHD and those with heart failure and reduced ejection fractions.3 The current study, the most comprehensive meta-analysis of this issue to date, suggests that the addition of fish oil as a supplementation does not decrease the risk of heart disease in either those with existent cardiovascular illness or in those at high risk for cardiovascular disease. It may be beneficial to replace unhealthy choices with fish in the diet, but adding fish oil does not appear to decrease risk. —Neil Skolnik, MD

  1. Kromhout D, Bosschieter EB, de Lezenne Coulander C. The inverse relation between fish consumption and 20-year mortality from coronary heart disease. N Engl J Med. 1985;312(19):1205-1209.
  2. Burr ML, Fehily AM, Gilbert JF, et al. Effects of changes in fat, fish, and fibre intakes on death and myocardial reinfarction: Diet and Reinfarction Trial (DART). Lancet. 1989;2(8666):757-761.
  3. Siscovick DS, Barringer TA, Fretts AM, et al; American Heart Association Nutrition Committee of the Council on Lifestyle and Cardiometabolic Health; Council on Epidemiology and Prevention; Council on Cardiovascular Disease in the Young; Council on Cardiovascular and Stroke Nursing; Council on Clinical Cardiology. Omega-3 polyunsaturated fatty acid (fish oil) supplementation and the prevention of clinical cardiovascular disease: a science advisory from the American Heart Association. Circulation. 2017;135(15):e867-e884.

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