Effects of Fish Oil on Prevention of Cardiovascular Events: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

 TANG Wenjuan ¹ , TANG Haiqin ¹ , YANG Linlin ¹ , WANG Xiaqin ¹ , SUN Yeheng ² , HUANG Xiaohui ³

1. Department of Geriatrics, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, China;2. School of Public Health, Anhui Medical University, Hefei 230022, China;3. School of Pharmacy, Anhui Medical University, Hefei 230022, China;

Corresponding author：

TANG Wenjuan, Email: tanghq898@sina.com

Keywords：

n-3 Polyunsaturated fatty acids (n-3 PUFAs); Fish oil; Cardiovascular disease; Meta-analysis

DOI：

10.7507/1672-2531.20090216

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective 　To evaluate the efficacy of n-3 PUFAs (fish oil) for prevention of cardiovascular events.
Methods 　Randomized controlled trials (RCTs) were searched from the following electronic databases: PubMed, EMbase, The Cochrane Library (Issue 1, 2009), CBM, and CNKI. Quality assessment and data extraction were conducted by two reviewers independently. Disagreement was resolved through discussion. All data were analyzed by using Review Manager 4.2 software.
Results 　Five studies involving 37 689 participants met the inclusion criteria. Meta-analysis results showed that: 1) Compared with placebo, the incidence rates of the cardiovascular death (RR=0.91, 95% CI 0.84 to 0.98), cardiovascular events (RR=0.95, 95%CI 0.91 to 0.98), angina (RR=0.79, 95%CI 0.64 to 0.96), and myocardial infarction (RR=0.79, 95%CI 0.65 to 0.96) could be reduced by n-3 PUFAs (fish oil). 2) There were no significant differences in death from any cause, the hospitalization rates of cardiovascular disease, sudden death, and heart failure (RR=0.95, 95%CI 0.90 to 1.00; RR=0.97, 95%CI 0.93 to 1.02; RR=0.90, 95%CI 0.79 to 1.01; RR=0.98, 95%CI 0.91 to 1.06). 3) Compared with placebo, the incidence rates of the arrhythmia and stroke could be increased, but there were no significant differences (RR=1.14, 95%CI: 0.80 to 1.62; RR=1.12, 95%CI 0.97 to 1.30).
Conclusion 　Compared with placebo, n-3 PUFAs (fish oil) has good effects on reducing the incidence rates of total cardiovascular events, cardiovascular death, myocardial infarction, and angina pectoris, and it has the same efficacy in death from all cause, sudden death, heart failure, and the hospitalization rates of cardiovascular disease. There are no significant differences in the increased rates of arrhythmia and stroke.

Citation： TANG Wenjuan,TANG Haiqin,YANG Linlin,WANG Xiaqin,SUN Yeheng,HUANG Xiaohui. Effects of Fish Oil on Prevention of Cardiovascular Events: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2009, 09(11): 1200-1206. doi: 10.7507/1672-2531.20090216 Copy

1.	Wang C, Harris WS, Chung M, et al. n-3 Fatty acids from fish or fish oil supplement, but not α-linolenicacid, benefitcardiovascular disease outcomes in primary- and secondary-prevention studies: a systematic review. Am J Clin Nutr, 2006, 84(1): 5-17.
2.	Landmrk K, Aim CS. Alpha-linolenic acid, cardiovascular disease and sudden death. Tidsskr Nor Laegeforen, 2006, 126(21): 2792-2794.
3.	Metcalf RG, Sanders P, James MJ, et al. Effect of dietary n-3 polyunsaturated fatty acids on the inducibility of ventricular tachy. Am J Cardiol, 2008, 101(6): 758-761.
4.	Hooper L, Thompson RL, Harrison RA, et al. Risks and benefits of omega 3 for mortality, cardiovascular disease and cancer, systematic review. BMJ, 2006, 332(7554): 752-760.
5.	Yokoyama M, Origasa H, Matsuzaki M, et al . Effects of eicosapentaenoic acid on major coronary events in hypercholesterolaemic patients (JELIS): a randomised open-label, blinded endpoint analysis. Lancet, 2007, 369(9567): 1090-1098.
6.	GISSI-HF Investigators, Tavazzi L, Maggioni AP, et al. Effect of n-3 polyunsaturated fatty acids in patients with chronic heart failure (the GISSI-HF trial): a randomised, double-blind, placebo-controlled trial. Lancet, 2008, 372(9645): 1223-1230.
7.	Merritt H, William E, Cynthia M, et al. Trial implantable defibrillators: a randomized controlled tachycardia and ventricular fibrillation in patients with fish oil supplementation and risk of ventricular. JAMA, 2005, 293(23): 2884-2891.
8.	Ingeborg A, Peter L, John C, et al. Effect of fish oil on ventricular tachyarrhythmia and ventricular arrhythmia (sofa) randomized trial defibrillators: the study on omega-3 fatty acids and death in patients with implantable cardioverter. JAMA, 2006, 295(22): 2613-2619.
9.	Roberto M, Federica B, Elena B, et al. Early Protection Against Sudden Death by n-3 Polyunsaturated Fatty Acids After Myocardial Infarction Time-Course Analysis of the Results of the Gruppo Italiano per lo Studio della Sopravvivenza nell’Infarto Miocardico (GISSI)-Prevenzione. Circulation, 2002, 105(4): 1897-1903.
10.	Harris WS. Fish oils and plasma lipid and lipoprotein metabolism in humans: a critical review. J Lipid Res, 1989, 30(6): 785-807.
11.	Hornstra G. Influence of dietary fish oil an arterial thrombosis and atherosclerosis in animal models and in man. J Intern Med Suppl, 1989, 731: 53-59.
12.	Weiner BH. Ockene IS, et al. Inhibition of atherosclerosis by codliver oil in a hyperlipidemic swine model. N Eng J Med, 1986, 315: 841-846.
13.	Dehmer GJ, Popma JJ, et al. Reduction in the rate of early restenosis after coronary angioplasty by a diet supplemented with n-3 fatty acids. N Eng J Med, 1988, 319: 733-740.
14.	Mclennan PL, Abevwardena MY, Charnock JS. Dietary fish oil prevents ventricular fibrillation following coronary artery occlusion and reperfusion. Am Heart J, 1988, 116(3): 709-717.
15.	王建中, 朱瑞龙, 邱仁芳, 等. 鱼油多不饱和脂肪酸对人血小板、红细胞必需脂肪酸组成以及过氧化-抗氧化能力的影响. 中国医药工业杂志, 1992, 23(2): 74-77.
16.	刘萍, 边强. 鱼油的药效作用研究, 国外医药—合成药生化药制剂分册, 2001, 22(6): 353-354.

1. Wang C, Harris WS, Chung M, et al. n-3 Fatty acids from fish or fish oil supplement, but not α-linolenicacid, benefitcardiovascular disease outcomes in primary- and secondary-prevention studies: a systematic review. Am J Clin Nutr, 2006, 84(1): 5-17.
2. Landmrk K, Aim CS. Alpha-linolenic acid, cardiovascular disease and sudden death. Tidsskr Nor Laegeforen, 2006, 126(21): 2792-2794.
3. Metcalf RG, Sanders P, James MJ, et al. Effect of dietary n-3 polyunsaturated fatty acids on the inducibility of ventricular tachy. Am J Cardiol, 2008, 101(6): 758-761.
4. Hooper L, Thompson RL, Harrison RA, et al. Risks and benefits of omega 3 for mortality, cardiovascular disease and cancer, systematic review. BMJ, 2006, 332(7554): 752-760.
5. Yokoyama M, Origasa H, Matsuzaki M, et al . Effects of eicosapentaenoic acid on major coronary events in hypercholesterolaemic patients (JELIS): a randomised open-label, blinded endpoint analysis. Lancet, 2007, 369(9567): 1090-1098.
6. GISSI-HF Investigators, Tavazzi L, Maggioni AP, et al. Effect of n-3 polyunsaturated fatty acids in patients with chronic heart failure (the GISSI-HF trial): a randomised, double-blind, placebo-controlled trial. Lancet, 2008, 372(9645): 1223-1230.
7. Merritt H, William E, Cynthia M, et al. Trial implantable defibrillators: a randomized controlled tachycardia and ventricular fibrillation in patients with fish oil supplementation and risk of ventricular. JAMA, 2005, 293(23): 2884-2891.
8. Ingeborg A, Peter L, John C, et al. Effect of fish oil on ventricular tachyarrhythmia and ventricular arrhythmia (sofa) randomized trial defibrillators: the study on omega-3 fatty acids and death in patients with implantable cardioverter. JAMA, 2006, 295(22): 2613-2619.
9. Roberto M, Federica B, Elena B, et al. Early Protection Against Sudden Death by n-3 Polyunsaturated Fatty Acids After Myocardial Infarction Time-Course Analysis of the Results of the Gruppo Italiano per lo Studio della Sopravvivenza nell’Infarto Miocardico (GISSI)-Prevenzione. Circulation, 2002, 105(4): 1897-1903.
10. Harris WS. Fish oils and plasma lipid and lipoprotein metabolism in humans: a critical review. J Lipid Res, 1989, 30(6): 785-807.
11. Hornstra G. Influence of dietary fish oil an arterial thrombosis and atherosclerosis in animal models and in man. J Intern Med Suppl, 1989, 731: 53-59.
12. Weiner BH. Ockene IS, et al. Inhibition of atherosclerosis by codliver oil in a hyperlipidemic swine model. N Eng J Med, 1986, 315: 841-846.
13. Dehmer GJ, Popma JJ, et al. Reduction in the rate of early restenosis after coronary angioplasty by a diet supplemented with n-3 fatty acids. N Eng J Med, 1988, 319: 733-740.
14. Mclennan PL, Abevwardena MY, Charnock JS. Dietary fish oil prevents ventricular fibrillation following coronary artery occlusion and reperfusion. Am Heart J, 1988, 116(3): 709-717.
15. 王建中, 朱瑞龙, 邱仁芳, 等. 鱼油多不饱和脂肪酸对人血小板、红细胞必需脂肪酸组成以及过氧化-抗氧化能力的影响. 中国医药工业杂志, 1992, 23(2): 74-77.
16. 刘萍, 边强. 鱼油的药效作用研究, 国外医药—合成药生化药制剂分册, 2001, 22(6): 353-354.

Chinese Journal of Evidence-Based Medicine

Effects of Fish Oil on Prevention of Cardiovascular Events: A Systematic Review

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