Tuesday, March 20, 2012

Effects of n-3 fatty acids on major cardiovascular events in statin users

These statistics seem to show that omega-3 are better at secondary prevention than statins.

Effects of n-3 fatty acids on major cardiovascular events in statin users and non-users with a history of myocardial infarction


Aims Recent secondary prevention trials have failed to demonstrate a beneficial effect of n-3 fatty acids on cardiovascular outcomes, which may be due to the growing use of statins since the mid-1990s. The aim of the present study was to assess whether statins modify the effects of n-3 fatty acids on major adverse cardiovascular events in patients with a history of myocardial infarction (MI).
Methods and results Patients who participated in the Alpha Omega Trial were divided into consistent statin users (n = 3740) and consistent statin non-users (n = 413). In these two groups of patients, the effects of an additional daily amount of 400 mg eicosapentaenoic acid (EPA) plus docosahexaenoic acid (DHA), 2 g α-linolenic acid (ALA), or both on major cardiovascular events were evaluated. Multivariable Cox's proportional hazard models were used to calculate adjusted hazard rate ratios (HRadj). Among the statin users 495 (13%) and among the statin non-users 62 (15%) developed a major cardiovascular event. In statin users, an additional amount of n-3 fatty acids did not reduce cardiovascular events [HRadj 1.02; 95% confidence interval (CI): 0.80, 1.31; P = 0.88]. In statin non-users, however, only 9% of those who received EPA–DHA plus ALA experienced an event compared with 18% in the placebo group (HRadj 0.46; 95% CI: 0.21, 1.01; P= 0.051).
Conclusion In patients with a history of MI who are not treated with statins, low-dose supplementation with n-3 fatty acids may reduce major cardiovascular events. This study suggests that statin treatment modifies the effects of n-3 fatty acids on the incidence of major cardiovascular events.
ClinicalTrials.gov number: NCT00127452.

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1 comment:

  1. This study was not designed to compare statins versus fish oil plus ALA, given a large proportion of participants were already on a statin when entering the study. So, any interpretation regarding statins versus fish oil and ALA is indirect and limited.

    Nevertheless, we can surmise (mainly from Table 3);

    The study only involved post- MI persons
    The cohort going into the study were pretty well matched, irrespective of whether they were on a statin or not, apart from their total cholesterol and LDL numbers, which, among the statin users, were "better" (See Table 1 of the study, which gives a detailed breakdown of the base characteristics of those entering all of the arms of the study)
    Those doing nothing (i.e no statin, fish oil or ALA) for an average of 41 months had a 18% CVD event rate
    Those in the average 41 month statin (or plus placebo or fish oil and ALA) arms, had a CVD event rate of 13-14% - it appeared statins work to some extent
    Those in the average 41 month fish oil and ALA consuming, but no statin arm, had a CVD event rate of 9% - this also appeared to work
    Given the CVD event rate among the non-statin, fish oil and ALA arm was significantly better (in simple RRR terms >50% better) than among the statin arm, or the no statin or fish oil and ALA arms (RRR 100% better), one has to wonder whether no statin plus fish oil and ALA is the best post MI approach for many?


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