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Early Protection Against Sudden Death by n-3 Polyunsaturated Fatty Acids After Myocardial Infarction: Time-Course Analysis of the Results of the Gruppo Italiano per lo Studio della Sopravvivenza nell’Infarto Miocardico (GISSI)-Prevenzione
Abstract
Background — Our purpose was to assess the time course of the benefit of n-3 polyunsaturated fatty acids (PUFAs) on mortality documented by the GISSI-Prevenzione trial in patients surviving a recent (<3 months) myocardial infarction. Methods and Results — In this study, 11 323 patients were randomly assigned to supplements of n-3 PUFAs, vitamin E (300 mg/d), both, or no treatment (control) on top of optimal pharmacological treatment and lifestyle advice. Intention-to-treat analysis adjusted for interaction between treatments was carried out. Early efficacy of n-3 PUFA treatment for total, cardiovascular, cardiac, coronary, and sudden death; nonfatal myocardial infarction; total coronary heart disease; and cerebrovascular events was assessed by right-censoring follow-up data 12 times from the first month after randomization up to 12 months. Survival curves for n-3 PUFA treatment diverged early after randomization, and total mortality was significantly lowered after 3 months of treatment (relative risk [RR] 0.59; 95% CI 0.36 to 0.97; P =0.037). The reduction in risk of sudden death was specifically relevant and statistically significant already at 4 months (RR 0.47; 95% CI 0.219 to 0.995; P =0.048). A similarly significant, although delayed, pattern after 6 to 8 months of treatment was observed for cardiovascular, cardiac, and coronary deaths. Conclusions — The early effect of low-dose (1 g/d) n-3 PUFAs on total mortality and sudden death supports the hypothesis of an antiarrhythmic effect of this drug. Such a result is consistent with the wealth of evidence coming from laboratory experiments on isolated myocytes, animal models, and epidemiological and clinical studies.
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“contemporary high-intensity statin formulations achieve greater low-density lipoprotein–lowering effects and cardiovascular endpoint reduction than were used during the first mixed EPA/DHA trials, such as GISSI-P.17,27,44”
From Effects of Eicosapentaenoic Acid vs Eicosapentaenoic/Docosahexaenoic Acids on Cardiovascular Mortality (2025) · cites this paper as [44]
Experimental — accuracy not yet measuredIn the citing paper
“Data from meta-analyses suggest that a reduction of calculated glomerular filtration rate (GFR) does not reflect any adverse effects on kidney function [315].”
From 2019 ESC/EAS guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk (2019) · cites this paper as [315]
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“Results from other meta-analyses suggest reduced major CVD events in patients with high TGs and low HDL-C in fibrate-treated patients, but no decrease in CVD or total mortality [314-316].”
From 2019 ESC/EAS guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk (2019) · cites this paper as [315]
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“A post hoc subgroup analysis revealed that this reduction in mortality and SCD was concentrated in the approximately 2000 patients with reduced left ventricular ejection fraction [67].”
From Update on Omega-3 Polyunsaturated Fatty Acids on Cardiovascular Health (2022) · cites this paper as [67]
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Metadata
- Authors
- Marchioli, R., Barzi, F., Bomba, E., Chieffo, C., Di Gregorio, D., Di Mascio, R., Franzosi, M. G., Geraci, E., Levantesi, G., Maggioni, A. P., Mantini, L., Marfisi, R. M., Mastrogiuseppe, G., Mininni, N., Nicolosi, G. L., Santini, M., Schweiger, C., Tavazzi, L., Tognoni, G., Tucci, C., & Valagussa, F.
- Affiliations
- Mario Negri Institute for Pharmacological Research (IT)
- From the Department of Clinical Pharmacology and Epidemiology, Consorzio Mario Negri Sud, Santa Maria Imbaro, Chieti (R.M., F.B., E.B., R.D.M., R.M.M., G.T.); Ospedale Civile, Caserta (C.C.); Ospedale Civile, Lanciano (D.D.G., L.M., G.M., C.T.); Department of Cardiovascular Research, Istituto Mario Negri, Milano (M.G.F.); Ospedale Cervello, Palermo (E.G.); Ospedale Civile, Vasto (G.L.); Centro Studi ANMCO, Firenze (A.P.M.); Ospedale Civile, Napoli (N.M.); Ospedale S. Maria degli Angeli, Pordenone (G...
- Corresponding author
- Marchioli, Roberto
- Venue
- Circulation
- Published
- 2002-04-23
- Volume
- 105
- Issue
- 16
- Pages
- 1897-1903
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- OpenAlex
- W2128788220
- Cited by
- 1,311
- References
- 36
- Citations by year
- 2026: 6 · 2025: 14 · 2024: 27 · 2023: 18 · 2022: 21 · 2021: 17 · 2020: 30 · 2019: 20 · 2018: 33 · 2017: 42 · 2016: 42 · 2015: 49 · 2014: 64 · 2013: 87 · 2012: 84
- FWCI
- 60.57
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Bristol-Myers Squibb
- Istituto di Ricerche Farmacologiche Mario Negri - IRCCS
- Topics
- Health Sciences › Nursing › Nutrition and Dietetics › Fatty Acid Research and Health
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Acute Myocardial Infarction Research
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Keywords
- omega-3 fatty acids, myocardial infarction, sudden death, mortality, vitamin E, antiarrhythmic effect, time course of treatment effects, cardiovascular mortality, coronary artery disease, cerebrovascular events
- MeSH terms
- Anti-Arrhythmia Agents, Female, Follow-Up Studies, Humans, Italy, Kinetics, Lipids, Male, Middle Aged, Myocardial Infarction, Fatty Acids, Omega-3, Death, Sudden, Cardiac, Dietary Supplements
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