Effects of omega-3 fatty acids on coronary restenosis, intima–media thickness, and exercise tolerance: A systematic review

doi:10.1016/j.atherosclerosis.2005.06.042

Atherosclerosis

Volume 184, Issue 2, February 2006, Pages 237-246

https://doi.org/10.1016/j.atherosclerosis.2005.06.042 Get rights and content

Abstract

Greater omega-3 fatty acid consumption is associated with reduced cardiovascular disease risk. Though the mechanisms of their effect are unclear, they may involve lesion formation and heart function. We conducted a systematic review of the clinical literature on the effect of omega-3 fatty acids on measures of vascular structure and function. We included studies that assessed fish and plant sources of omega-3 fatty acids on coronary artery restenosis after angioplasty, carotid IMT, and exercise capacity. Compared to placebo, the summary risk ratio of coronary artery restenosis with fish oil is 0.87 (95% CI 0.73, 1.05) across 12 randomized controlled trials. Two prospective studies reported increased carotid IMT, whereas two cross-sectional studies reported a reduction of IMT, with fish, fish oil or ALA consumption. Three randomized trials and three uncontrolled studies reported small non-significant improvements in exercise capacity with fish oil. Overall, little or no effect of fish oil was found for a variety of markers of cardiovascular disease risk. There are insufficient studies to draw conclusions about the effect of ALA. The dearth of long term data on fish consumption or omega-3 fatty acid supplementation on measures of cardiovascular disease risk severely limits our ability to draw definitive conclusions at this time.

Section snippets

Background

Reports identifying a potential relationship between fatty fish intake and decreased risk of developing cardiovascular disease began to emerge in the late 1970s from the work of Bang and Dyerberg in Greenland Inuits [1], [2], [3]. Subsequently, this finding has been extended to other population groups including South Pacific Islanders, Japanese, and indigenous Alaskans [4], [5], [6]. The lower prevalence of cardiovascular disease was found to be independent of other established risk factors [7]

Literature search

We conducted a comprehensive literature search to identify the English-language literature on omega-3 fatty acids and cardiovascular disease in MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Biological Abstracts, and Commonwealth Agricultural Bureau databases through April 2003. Search terms included the specific omega-3 fatty acids, fish and other marine oils, and omega-3 fatty acid-rich plant oils. We also reviewed additional publications found by domain experts.

Definitions of omega-3 fatty acids

The omega-3

Results

The literature search for all studies of omega-3 fatty acids and cardiovascular disease related conditions yielded 7464 citations. We retrieved and reviewed 807 articles to analyze cardiovascular events, risk factors and intermediate markers. Of these we analyzed 123 articles about 23 different cardiovascular disease risk factors and intermediate markers. Here we discuss the 22 studies that reported data on the effect of omega-3 fatty acid consumption on the evaluated vascular markers.

Among the

Discussion

A large body of literature has evolved over the past several years examining the effects of omega-3 fatty acids on cardiovascular risk. The majority of the literature has examined the associations between higher fish intake or omega-3 fatty acid supplementation (primarily fish oil) and reduced incidence of clinical cardiovascular disease and death in cross-sectional or observational studies, or has examined the treatment effect of omega-3 fatty acid supplementation on serum markers of specific

Acknowledgments

This evidence report was prepared by the Tufts-New England Medical Center Evidence-based Practice Center under contract to the Agency for Healthcare Research and Quality (Contract No. 290-02-0023), Rockville, MD. Funding was provided by the Office of Dietary Supplements, National Institutes of Health. All authors report no conflict of interest or relevant financial disclosures.

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Adherence to a Mediterranean-style diet may be associated with the risk of vascular outcomes including stroke, cardiac disease, and cognitive impairment through its effects on blood vessels and related vascular damage. White matter lesions, brain infarction, and arterio/atherosclerosis are often subclinical. This chapter reviews the current evidence for a relationship between a Mediterranean diet and these subclinical vascular conditions. While some studies support a potential role of adherence to a Mediterranean diet in decreasing the burden of these subclinical vascular conditions, limited research has been conducted; therefore, the findings are scant and inconclusive. More research is needed on whether such vascular damage lies on causal pathways linking a Mediterranean diet with clinical vascular events in order to help identify patients who may benefit most from dietary changes and to support the use of these common subclinical markers in future clinical trials examining dietary interventions for improving brain health.
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Citation Excerpt :
Following the structure of the original report [12], we treated the evaluation of fish oils and alpha-linolenic acid (ALA) as two separate systematic reviews for the current analysis. Together, the original report [12] and accompanying journal articles [15,16] included meta-analyses for nine of 26 analyzed CVD risk factors with fish oil and no meta-analyses for 24 CVD risk factors with ALA. The literature search yielded 54 new primary studies and six new systematic reviews.
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We applied the RAND method, which uses domain (subject matter) expert guidance, and a modified Ottawa method, which uses quantitative and qualitative signals. For both methods, we conducted focused electronic literature searches of recent studies using the key terms from the original reports. We assessed the agreement between the methods and qualitatively assessed the merits of each system.
Agreement between the two methods was “substantial” or better (kappa > 0.62) in three of the four systematic reviews. Overall agreement between the methods was “substantial” (kappa = 0.64, 95% confidence interval [CI] 0.45–0.83).
The RAND and modified Ottawa methods appear to provide similar signals for the possible need to update systematic reviews in this pilot study. Future evaluation with a broader range of clinical topics and eventual comparisons between signals to update reports and the results of full evidence review updates will be needed. We propose a hybrid approach combining the best features of both methods, which should allow efficient review and assessment of the need to update.
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ReviewEffects of omega-3 fatty acids on coronary restenosis, intima–media thickness, and exercise tolerance: A systematic review

Abstract

Section snippets

Background

Literature search

Definitions of omega-3 fatty acids

Results

Discussion

Acknowledgments

The composition of the Eskimo food in north western Greenland

Am J Clin Nutr

Eicosapentaenoic acid and prevention of thrombosis and atherosclerosis?

Lancet

The composition of food consumed by Greenland Eskimos

Acta Med Scand

Apparent absence of stroke and ischaemic heart disease in a traditional Melanesian island: a clinical study in Kitava

J Intern Med

Eicosapentaenoic acid and adult diseases in Japan: epidemiological and clinical aspects

J Intern Med Suppl

Cardiac mortality in Alaska's indigenous and non-Native residents

Int J Epidemiol

Fish consumption and coronary heart disease mortality in Finland, Italy, and The Netherlands

Am J Epidemiol

Blood levels of long-chain n − 3 fatty acids and the risk of sudden death

New Engl J Med

Cardiovascular disease and long-chain omega-3 fatty acids

Curr Opin Lipidol

Antiarrhythmic effects of polyunsaturated fatty acids. Recent studies

Circulation

n − 3 polyunsaturated fatty acids and coronary thrombosis

Lipids

Cardiovascular effects of n − 3 fatty acids

New Engl J Med

Meta-analysis in clinical trials

Contr Clin Trials

K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Kidney Disease Outcome Quality Initiative

Am J Kidney Dis Suppl

Randomised trial of fish oil for prevention of restenosis after coronary angioplasty

Lancet

Fish oils and low-molecular-weight heparin for the reduction of restenosis after percutaneous transluminal coronary angioplasty. The EMPAR Study

Circulation

Reduction in the rate of early restenosis after coronary angioplasty by a diet supplemented with n − 3 fatty acids

New Engl J Med

n − 3 fatty acids do not prevent restenosis after coronary angioplasty: results from the CART study. Coronary Angioplasty Restenosis Trial

J Am Coll Cardiol

Review
Effects of omega-3 fatty acids on coronary restenosis, intima–media thickness, and exercise tolerance: A systematic review