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Title: Omega-3 fatty acids from fish oil supplements, but not alpha-linolenic acid benefit cardiovascular disease outcomes in primary & secondary prevention studies: a systematic review

Author
item WANG, CHENCHEN - TUFTS-NEMC
item HARRIS, WILLIAM - UNIV MISSOURI-KANSAS CITY
item CHUNG, MEI - TUFTS-NEMC
item Lichtenstein, Alice
item BALK, ETHAN - TUFTS-NEMC
item KUPELNICK, BRUCE - TUFTS-NEMC
item JORDAN, HARMON - ABT ASSOC INC
item LAU, JOSEPH - TUFTS-NEMC

Submitted to: The American Journal of Clinical Nutrition
Publication Type: Review Article
Publication Acceptance Date: 1/22/2006
Publication Date: 7/1/2006
Citation: Wang, C., Harris, W.S., Chung, M., Lichtenstein, A.H., Balk, E.M., Kupelnick, B., Jordan, H.S., Lau, J. 2006. Omega-3 fatty acids from fish oil supplements, but not alpha-linolenic acid benefit cardiovascular disease outcomes in primary & secondary prevention studies: a systematic review. American Journal of Clinical Nutrition. 84(1):5-17.

Interpretive Summary:

Technical Abstract: The relationship between dietary omega-3 fatty acids and cardiovascular disease is uncertain. The published literature is replete with studies of varying methodological quality and sometimes contradictory results. The objective of this work was to conduct a systematic review and critical appraisal of the clinical literature on the effects on cardiovascular disease outcomes and adverse events of omega-3 fatty acids (consumed as fish or fish oils rich in eicosapentaenoic acid [EPA] and docosahexaenoic acid [DHA], or as alpha-linolenic acid [ALA]). From MEDLINE and other sources, studies of at least 1-year duration that reported estimates of fish or omega-3 fatty acid intake and cardiovascular disease outcomes were included. The results of this work indicated that for secondary prevention there were 11 randomized controlled trials (RCTs) of fish oil supplements or high omega-3 fatty acid diets, and one prospective cohort study. Most trials reported that fish oil significantly reduced all-cause mortality, myocardial infarction, cardiac and sudden death, and/or stroke. Primary prevention of cardiovascular disease was reported in one RCT, 25 prospective cohort studies, and 7 case-control studies. Most cohort studies reported that fish consumption was associated with lower rates of all-cause mortality and cardiac outcomes. The effects on stroke were inconsistent. The cumulative evidence suggests that increased consumption of omega-3 fatty acids from fish or fish oil supplements, but not ALA, reduces the rates of all-cause mortality, cardiac and sudden death, and/or stroke. The evidence for the benefits of fish oil is stronger in secondary than primary prevention settings. Adverse effects appear to be minor.