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Lack of benefit of dietary advice to men with angina: results of a controlled trial
Abstract
Objective To see whether mortality among men with angina can be reduced by dietary advice.Design A randomized controlled factorial trial.Setting Male patients of general practitioners in south Wales.Subjects A total of 3114 men under 70 y of age with angina.Interventions Subjects were randomly allocated to four groups: (1) advised to eat two portions of oily fish each week, or to take three fish oil capsules daily; (2) advised to eat more fruit, vegetables and oats; (3) given both the above types of advice; and (4) given no specific dietary advice. Mortality was ascertained after 3-9 y.Results Compliance was better with the fish advice than with the fruit advice. All-cause mortality was not reduced by either form of advice, and no other effects were attributable to fruit advice. Risk of cardiac death was higher among subjects advised to take oily fish than among those not so advised; the adjusted hazard ratio was 1.26 (95% confidence interval 1.00, 1.58; P=0.047), and even greater for sudden cardiac death (1.54; 95% CI 1.06, 2.23; P=0.025). The excess risk was largely located among the subgroup given fish oil capsules. There was no evidence that it was due to interactions with medication.Conclusions Advice to eat more fruit was poorly complied with and had no detectable effect on mortality. Men advised to eat oily fish, and particularly those supplied with fish oil capsules, had a higher risk of cardiac death. This result is unexplained; it may arise from risk compensation or some other effect on patients' or doctors' behaviour.
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“There are also some opposite data on the possible effect of polyunsaturated omega-3 fatty acids (PUFA) on sudden cardiac death (138,139).”
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Metadata
- Authors
- Burr, M. L., Ashfield-Watt, P. A. L., Dunstan, F. D. J., Fehily, A. M., Breay, P., Ashton, T., Zotos, P. C., Haboubi, N. A. A., & Elwood, P. C.
- Affiliations
- Cardiff University (GB)
- Corresponding author
- Burr, M L
- Venue
- European Journal of Clinical Nutrition
- Published
- 2003-02-01
- Volume
- 57
- Issue
- 2
- Pages
- 193-200
- ISSN
- 0954-3007 (ISSN-L)
- 1476-5640
- OpenAlex
- W2095073323
- Cited by
- 409
- References
- 30
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 2 · 2023: 1 · 2022: 7 · 2021: 3 · 2020: 8 · 2019: 10 · 2018: 19 · 2017: 11 · 2016: 18 · 2015: 17 · 2014: 14 · 2013: 22 · 2012: 27
- FWCI
- 30.10
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- European Journal of Clinical Nutrition (publishedVersion)
- PubMed (publishedVersion)
- ORCA Online Research @Cardiff (Cardiff University) (submittedVersion)
- Funders
- British Heart Foundation
- Topics
- Health Sciences › Nursing › Nutrition and Dietetics › Fatty Acid Research and Health
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Keywords
- angina pectoris, dietary recommendations, oily fish, fish oil capsules, fruit and vegetable intake, oat, all-cause mortality, cardiovascular mortality, sudden cardiac death, dietary adherence, risk compensation, men
- MeSH terms
- Angina Pectoris, Diet, Fatty Acids, Unsaturated, Fish Oils, Fruit, Humans, Male, Middle Aged, Time Factors, Vegetables, Wales, Eicosapentaenoic Acid, Survival Analysis, Avena, beta Carotene, Nutritional Sciences
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