Low dose omega 3 supplementation in cad

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In this RC trial omega-3 fat supplementation as margarine did not bring any benefit in patients with recent myocardial infarction

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Low dose omega 3 supplementation in cad

  1. 1. www.pronutritionist.net n–3 Fatty Acids and Cardiovascular Events after Myocardial Infarction Kromhout D et al. N Engl J Med 2010; August 29. (e-pub ahead of print) Page 1 Kromhout D et al. N Engl J Med 2010; August 29. (e-pub ahead of print)
  2. 2. Page 2 Background • Resent studies have shown that supplementation with eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) may reduce – cardiovascular and all-cause mortality with patients with cardiac disease (GISSI-Prevenzione Investigators 1999) – the risk of fatal coronary heart disease (JELIS Study, only EPA supplementation, Yomoyoma et al. 2007) • A protective effect of the plant-derived n−3 fatty acid alpha-linolenic acid (ALA) is less studied • Cohort studies have suggested that low doses of n−3 fatty acids should be sufficient to reduce cardiovascular risk Kromhout D et al. N Engl J Med 2010; August 29. (e-pub ahead of print) www.pronutritionist.net
  3. 3. Methods (1/2) • double-blind, placebo-controlled trial • n = 4837 (age 60-80 years) – all had had a myocardial infarction and were receiving state-of-the-art antihypertensive, antithrombotic, and lipidmodifying therapy – 78 % were men • Patients were randomly assigned to four groups: – a margarine supplemented with a combination of EPA and DHA – a margarine supplemented with ALA – a margarine supplemented with EPA–DHA and ALA – a placebo margarine Page 3 Kromhout D et al. N Engl J Med 2010; August 29. (e-pub ahead of print) www.pronutritionist.net
  4. 4. Methods (2/2) • All patients were given placebo margarine during the first 4 to 6 weeks after randomization • Study duration was 40 months • The primary end point: – fatal and nonfatal cardiovascular events and cardiac interventions • Secondary end points: – incident of cardiovascular disease – fatal cardiovascular disease – fatal coronary heart disease – ventricular-arrhythmia -related events – death from any cause www.pronutritionist.netKromhout D et al. N Engl J Med 2010; August 29. (e-pub ahead of print) 4
  5. 5. Results (1/3) • mean intake of trial margarine was 18.8±4.7 g per day – 90.5% of the patients consumed a mean of 20.6±2.8 g per day • patients in EPA–DHA groups received – 226 mg of EPA and 150 mg of DHA per day • Baseline intake of EPA-DHA was 120-130 mg per day • patients in ALA groups received – 1.9 g of ALA per day • Adverse effects did not differ between the groups Page 5 Kromhout D et al. N Engl J Med 2010; August 29. (e-pub ahead of print) www.pronutritionist.net
  6. 6. Results 2/3 www.pronutritionist.netKromhout D et al. N Engl J Med 2010; August 29. (e-pub ahead of print) 6 P=0.93 P=0.20 All treatments provided as margarines
  7. 7. Results (3/3) • Low-dose supplementation with EPA–DHA or ALA did not significantly reduce the rate of major cardiovascular events – However, there was a 27% reduction in major cardiovascular events with ALA among women vs EPA-DHA or placebo • Patients with diabetes had a higher risk of all cardiovascular end points than did patients without diabetes www.pronutritionist.netKromhout D et al. N Engl J Med 2010; August 29. (e-pub ahead of print) 7
  8. 8. Discussion • Previous randomized, controlled trials involving patients with cardiac disease or at risk, did show protective effects of EPA, either with or without DHA, on various composite cardiovascular end points • This discrepancy between those trials and current one may be related to differences between patient populations in – age – sex distribution – presence or absence of a history of coronary artery disease • Authors did not speculate in their discussion if total intake of EPA+DHA c. 500 mg (376 mg from margarine & dietary baseline intake of 120-130 mg) was insufficient. In JELIS and GISSI Prevenzione studies supplementation of EPA and DHA was at least double (1 800 mg EPA and 850 mg EPA+DHA respectively). It is possible that higher intake of omega-3 fatty acids is required Page 8 Kromhout D et al. N Engl J Med 2010; August 29. (e-pub ahead of print) www.pronutritionist.net

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