Effects of omega-3 fatty acids on coronary revascularization and cardiovascular events: a meta-analysis
Open accessAbstract
Aims: Benefits of pharmacologic omega-3 fatty acid administration in cardiovascular prevention are controversial. Particularly, effects on coronary revascularization are unclear; also debated are specific benefits of eicosapentaenoic acid (EPA). We investigated incident coronary revascularizations, myocardial infarction (MI), stroke, heart failure (HF), unstable angina, and cardiovascular death, in subjects randomized to receive EPA or EPA + docosahexaenoic acid (EPA + DHA) vs. control. Methods and results: Meta-analysis of randomized controlled trials (RCTs) was conducted after MEDLINE, Embase, Scopus, Web of Science, and Cochrane Library search. Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines were followed for abstracting data and assessing data quality and validity. Data were pooled using a random effects model. Eighteen RCTs with 134 144 participants (primary and secondary cardiovascular prevention) receiving DHA + EPA (n = 52 498), EPA alone (n = 14 640), or control/placebo (n = 67 006) were included. Follow-up ranged from 4.5 months to 7.4 years. Overall, compared with controls, omega-3 supplementation reduced the risk of revascularization [0.90, 95% confidence interval (CI) 0.84–0.98; P = 0.001; P-heterogeneity = 0.0002; I2 = 68%], MI (0.89, 95% CI 0.81–0.98; P = 0.02; P-heterogeneity = 0.06; I2 = 41%), and cardiovascular death (0.92, 95% CI 0.85–0.99; P = 0.02; P-heterogeneity = 0.13; I2 = 33%). Lower risk was still observed in trials where most participants (≥60%) were on statin therapy. Compared with DHA + EPA, EPA alone showed a further significant risk reduction of revascularizations (0.76, 95% CI 0.65–0.88; P = 0.0002; P-interaction = 0.005) and all outcomes except HF. Conclusion: Omega-3 fatty acid supplementation reduced the risk of cardiovascular events and coronary revascularization, regardless of background statin use. Eicosapentaenoic acid alone produced greater benefits. The role of specific omega-3 molecules in primary vs. secondary prevention and the potential benefits of reduced revascularizations on overall health status and cost savings warrant further research.
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- Authors
- Dinu, M., Sofi, F., Lotti, S., Colombini, B., Mattioli, A. V., Catapano, A. L., Casula, M., Baragetti, A., Wong, N. D., Steg, P. G., & Ambrosio, G.
- Affiliations
- University of Florence (IT)
- Azienda Ospedaliero-Universitaria Careggi (IT)
- University of Modena and Reggio Emilia (IT)
- University of Milan (IT)
- University of California, Irvine (US)
- Université Paris-Cité, INSERM U1148, FACT French Alliance for Cardiovascular Trials, AP-HP Hopital Bichat , Paris , France
- University of Perugia (IT)
- ORCID
- Venue
- European Journal of Preventive Cardiology
- Publisher
- Oxford University Press (OUP)
- Published
- 2024-06-13
- Volume
- 31
- Issue
- 15
- Pages
- 1863-1875
- ISSN
- 2047-4873 (ISSN-L)
- 2047-4881
- OpenAlex
- W4399633614
- Semantic Scholar
- 35186fe50a50d40e47e3e3ebd0660ccc45bfa70b
- Cited by
- 17
- References
- 66
- Citations by year
- 2026: 3 · 2025: 9 · 2024: 5
- FWCI
- 1.69
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- European Journal of Preventive Cardiology (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Archivio Istituzionale della Ricerca (Universita Degli Studi Di Milano) (submittedVersion, other-oa)
- Archivio istituzionale della ricerca (Alma Mater Studiorum Università di Bologna) (submittedVersion, cc-by)
- Florence Research (University of Florence) (submittedVersion, cc-by)
- Funders
- Italian Ministry of Health
- IRCCS MultiMedica
- 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
- omega-3 fatty acids, eicosapentaenoic acid, docosahexaenoic acid, coronary revascularization, myocardial infarction, cardiovascular mortality, stroke, heart failure, unstable angina, statin therapy, cardiovascular disease prevention, omega-3 supplementation, lipid-lowering therapy, cardiovascular risk reduction, n-6/n-3 ratio
- MeSH terms
- Aged, Cardiovascular Diseases, Docosahexaenoic Acids, Female, Humans, Male, Middle Aged, Myocardial Revascularization, Risk Factors, Eicosapentaenoic Acid, Fatty Acids, Omega-3, Randomized Controlled Trials as Topic, Treatment Outcome, Risk Assessment, Dietary Supplements, Secondary Prevention
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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