Omega-3 polyunsaturated fatty acid (fish oil) supplementation and the prevention of clinical cardiovascular disease

Authors: SIOSCOVIK, DAVID - New York Academy Of Medicine; BARRINGER, THOMAS - Novant Heart Health & Vascular Institute; FRETTS, AMANDA - University Of Washington; WU, JASON - The George Institute For Global Health; LICHTENSTEIN, ALICE - Jean Mayer Human Nutrition Research Center On Aging At Tufts University; COSTELLO, REBECCA - National Institutes Of Health (NIH); KRIS-ETHERTON, PENNY - Pennsylvania State University; JACOBSON, TERRY - Emory University, School Of Medicine; ENGLER, MARY - National Institutes Of Health (NIH); ALGER, HEATHER - American Heart Association; APPEL, LAWRENCE - Johns Hopkins University; MOZAFFARIAN, DARIUSH - Friedman School At Tufts

Submitted to: Circulation
Publication Type: Other
Publication Acceptance Date: 10/25/2016
Publication Date: 3/13/2017
Citation: Sioscovik, D.S., Barringer, T.A., Fretts, A.M., Wu, J., Lichtenstein, A.H., Costello, R.B., Kris-Etherton, P.M., Jacobson, T.A., Engler, M.B., Alger, H.M., Appel, L.J., Mozaffarian, D. 2017. Omega-3 polyunsaturated fatty acid (fish oil) supplementation and the prevention of clinical cardiovascular disease. Circulation. 135:e1-e20.

Interpretive Summary:

Technical Abstract: Multiple randomized controlled trials (RCTs) have assessed the effects of supplementation with eicosapentaenoic acid plus docosahexaenoic acid (omega-3 polyunsaturated fatty acids, commonly called fish oils) on the occurrence of clinical cardiovascular diseases. Although the effects of supplementation for the primary prevention of clinical cardiovascular events in the general population have not been examined, RCTs have assessed the role of supplementation in secondary prevention among patients with diabetes mellitus and prediabetes, patients at high risk of cardiovascular disease, and those with prevalent coronary heart disease. In this scientific advisory, we take a clinical approach and focus on common indications for omega-3 polyunsaturated fatty acid supplements related to the prevention of clinical cardiovascular events. We limited the scope of our review to large RCTs of supplementation with major clinical cardiovascular disease end points; meta-analyses were considered secondarily. We discuss the features of available RCTs and provide the rationale for our recommendations. We then use existing American Heart Association criteria to assess the strength of the recommendation and the level of evidence. On the basis of our review of the cumulative evidence from RCTs designed to assess the effect of omega-3 polyunsaturated fatty acid supplementation on clinical cardiovascular events, we update prior recommendations for patients with prevalent coronary heart disease, and we offer recommendations, when data are available, for patients with other clinical indications, including patients with diabetes mellitus and prediabetes and those with high risk of cardiovascular disease, stroke, heart failure, and atrial fibrillation.