Omega-3 fatty acids for the primary and secondary prevention of cardiovascular disease

Background: Researchers have suggested that omega-3 polyunsaturated fatty acids from oily fish (long-chain omega-3 (LCn3), including eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA)), as well as from plants (alpha-linolenic acid (ALA)) benefit cardiovascular health. Guidelines recommend increasing omega-3-rich foods, and sometimes supplementation, but recent trials have not confirmed this. Objectives: To assess effects of increased intake of fish- and plant-based omega-3 for all-cause mortality, cardiovascular (CVD) events, adiposity and lipids. Search methods: We searched CENTRAL, MEDLINE and Embase to April 2017, plus ClinicalTrials.gov and World Health Organization International Clinical Trials Registry to September 2016, with no language restrictions. We handsearched systematic review references and bibliographies and contacted authors. Selection criteria: We included randomised controlled trials (RCTs) that lasted at least 12 months and compared supplementation and/or advice to increase LCn3 or ALA intake versus usual or lower intake. Data collection and analysis: Two review authors independently assessed studies for inclusion, extracted data and assessed validity. We performed separate random-effects meta-analysis for ALA and LCn3 interventions, and assessed dose-response relationships through meta-regression. Main results: We included 79 RCTs (112,059 participants) in this review update and found that 25 were at low summary risk of bias. Trials were of 12 to 72 months' duration and included adults at varying cardiovascular risk, mainly in high-income countries. Most studies assessed LCn3 supplementation with capsules, but some used LCn3- or ALA-rich or enriched foods or dietary advice compared to placebo or usual diet. Meta-analysis and sensitivity analyses suggested little or no effect of increasing LCn3 on all-cause mortality (RR 0.98, 95% CI 0.90 to 1.03, 92,653 participants; 8189 deaths in 39 trials, high-quality evidence), cardiovascular mortality (RR 0.95, 95% CI 0.87 to 1.03, 67,772 participants; 4544 CVD deaths in 25 RCTs), cardiovascular events (RR 0.99, 95% CI 0.94 to 1.04, 90,378 participants; 14,737 people experienced events in 38 trials, high-quality evidence), coronary heart disease (CHD) mortality (RR 0.93, 95% CI 0.79 to 1.09, 73,491 participants; 1596 CHD deaths in 21 RCTs), stroke (RR 1.06, 95% CI 0.96 to 1.16, 89,358 participants; 1822 strokes in 28 trials) or arrhythmia (RR 0.97, 95% CI 0.90 to 1.05, 53,796 participants; 3788 people experienced arrhythmia in 28 RCTs). There was a suggestion that LCn3 reduced CHD events (RR 0.93, 95% CI 0.88 to 0.97, 84,301 participants; 5469 people experienced CHD events in 28 RCTs); however, this was not maintained in sensitivity analyses - LCn3 probably makes little or no difference to CHD event risk. All evidence was of moderate GRADE quality, except as noted. Increasing ALA intake probably makes little or no difference to all-cause mortality (RR 1.01, 95% CI 0.84 to 1.20, 19,327 participants; 459 deaths, 5 RCTs),cardiovascular mortality (RR 0.96, 95% CI 0.74 to 1.25, 18,619 participants; 219 cardiovascular deaths, 4 RCTs), and it may make little or no difference to CHD events (RR 1.00, 95% CI 0.80 to 1.22, 19,061 participants, 397 CHD events, 4 RCTs, low-quality evidence). However, increased ALA may slightly reduce risk of cardiovascular events (from 4.8% to 4.7%, RR 0.95, 95% CI 0.83 to 1.07, 19,327 participants; 884 CVD events, 5 RCTs, low-quality evidence), and probably reduces risk of CHD mortality (1.1% to 1.0%, RR 0.95, 95% CI 0.72 to 1.26, 18,353 participants; 193 CHD deaths, 3 RCTs), and arrhythmia (3.3% to 2.6%, RR 0.79, 95% CI 0.57 to 1.10, 4,837 participants; 141 events, 1 RCT). Effects on stroke are unclear. Sensitivity analysis retaining only trials at low summary risk of bias moved effect sizes towards the null (RR 1.0) for all LCn3 primary outcomes except arrhythmias, but for most ALA outcomes, effect sizes moved to suggest protection. LCn3 funnel plots suggested that adding in missing studies/results would move effect sizes towards null for most primary outcomes. There were no dose or duration effects in subgrouping or meta-regression. There was no evidence that increasing LCn3 or ALA altered serious adverse events, adiposity or lipids, although LCn3 slightly reduced triglycerides and increased HDL. ALA probably reduces HDL (high- or moderate-quality evidence). Authors' conclusions: This is the most extensive systematic assessment of effects of omega-3 fats on cardiovascular health to date. Moderate- and high-quality evidence suggests that increasing EPA and DHA has little or no effect on mortality or cardiovascular health (evidence mainly from supplement trials). Previous suggestions of benefits from EPA and DHA supplements appear to spring from trials with higher risk of bias. Low-quality evidence suggests ALA may slightly reduce CVD event risk, CHD mortality and arrhythmia

Obituary-Serge C. Renaud.

International audienc

Rôle de l'acide alpha-linolénique dans la prévention des maladies cardio-vasculaires et des troubles du rythme cardiaque (effet de l'acide alpha-linolénique sur la prévention des récidives de fibrillation auriculaire, étude pilote sur un groupe de 98 patients)

98 patients hospitalisés pour recevoir un choc électrique sur fibrillation auriculaire ont été randomisés en 2 groupes : l'un recevant de l'huile et de la margarine de colza, riche en ALA, et l'autre recevant les conseils habituels donnés aux cardiaques. Sur ce groupe de 98 patients âgés de 67.1 _+ 6.41 ans, on a pu observer : - une compliance de 77 % avec 75 patients ayant bien suivi le régime de leur groupe, passant de 0.65 _+ 0.35 g/j d'ALA à 2.08 _+ 0.85 g/j après 2 mois dans le groupe expérimental, leur taux plasmatique d'ALA passant de 0.41 _+ 0.20 % à 0.69 _+ 0.26 %. -une très bonne tolérance au régime, sans modifications de leur équilibre alimentaire ni effets secondaires. - Un taux de récidive dans ce groupe de 75 patients passant de 48.5 % à 6 mois pour le groupe témoin, à 22.5 % (p = 0.017) dans le groupe d'intervention, et de 54.3 % à 12 mois, à 32.5 % (p = 0.057). Il s'agit d'une étude pilote dont les résultats très intéressants appellent à la réalisation d'une étude clinique randomisée à plus grande échelle.98 patients included for a cardioversion for atrial fibrillation were randomized in 2 groups : an experimental group receiving rapeseed oil and rapeseed margarin, rich in ALA, and a control group receiving the usual advices given to cardiac patients. On these 98 patients 67.1 _+ 6.41 years old, we could observe : - a compliance of 77 % in 75 patients who followed carefully the diet of their group, diet ALA going from 0.65 _+ 0.35 g / day to 2.08 _+ 0.85 g / day after 2 months, and plasmatic ALA going from 0.41 _+ 0.20 % to 0.69 _+ 0.26 % in the experimental patients. - A good safety of the diet, with neither modifications in the well-balancing of the diet nor side effects. - A compliance rate for this group of 75 patients going from 48.5 % at 6 months in the control group, to 22.5 % (p = 0.017) in the experimental group, and from 54.3 % at 12 months in the control, to 32.5 % (p = 0.057) in the experimental group. These results are only those of a pilot study requiring confirmation with a much larger study.BORDEAUX2-BU Santé (330632101) / SudocPARIS-BIUP (751062107) / SudocSudocFranceF