5MinuteConsult Journal Club

Skip the Fish Oil for Heart Disease

References

Abdelhamid AS, Brown TJ, Brainard JS, et al. Omega-3 fatty acids for the primary and secondary prevention of cardiovascular disease. Cochrane Database Syst Rev. 2020 Feb 29;3(2):CD003177. doi: 10.1002/14651858.CD003177.pub5. PMID: 32114706.

Fiolet ATL, Opstal TSJ, Mosterd A, et al. Efficacy and safety of low-dose colchicine in patients with coronary disease: a systematic review and meta-analysis of randomized trials. Eur Heart J. 2021 Mar 26:ehab115. doi: 10.1093/eurheartj/ehab115. Epub ahead of print. PMID: 33769515.

Study Summary

This is systematic review and meta-analysis of randomized controlled trials on the effects of 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) on the primary and secondary prevention of cardiovascular disease. Observational data from many years ago found populations who ate large amounts of fatty fish had lower rates of cardiovascular disease. This study evaluated if taking any sort of fish oil supplement would influence outcomes.

Results:

No effect of increasing long chain omega 3s on all‐cause mortality (risk ratio [RR] 0.97, 95% confidence interval (CI) 0.93 to 1.01; high‐certainty evidence), cardiovascular mortality (RR 0.92, 95% CI 0.86 to 0.99; moderate‐certainty evidence), cardiovascular events (RR 0.96, 95% CI 0.92 to 1.01; high‐certainty evidence), stroke (RR 1.02, 95% CI 0.94 to 1.12; 1 moderate‐certainty evidence) or arrhythmia (RR 0.99, 95% CI 0.92 to 1.06; low‐certainty evidence)

Weak statistical reductions in coronary heart disease mortality (number needed to treat for an additional beneficial outcome [NNTB]) 334, RR 0.90, 95% CI 0.81 to 1.00; low‐certainty evidence) and coronary heart disease events (NNTB 167, RR 0.91, 95% CI 0.85 to 0.97; low‐certainty evidence)

Conclusion

There is no clinical benefit to use of fish oil supplementation for the primary and secondary prevention of CV disease.

Stats Refresher

Prevention: Primary, Secondary, Tertiary

• Primary Prevention—intervening before illness occurs, (eg. vaccinations, altering risky behaviors (poor eating habits, tobacco use), and banning dangerous substances)

• Secondary Prevention—screening to identify diseases before the onset of signs and symptoms (Breast Cancer: mammography, Hypertension: regular blood pressure testing)

• Tertiary Prevention—managing disease after diagnosis to slow or stop disease progression (chemotherapy, rehabilitation, and screening for complications)

Contributed by Frank J. Domino, MD, April 21, 2021