Beyond the Mediterranean Diet: The Role of Omega-3 Fatty Acids in the Prevention of Coronary Heart Disease

Charles R. Harper, MD, Terry A. Jacobson, MD

Disclosures

Prev Cardiol. 2003;6(3) 

In This Article

Angiographic Trials

The results from randomized controlled trials with fish oils and angiographic end points have been mixed. In a Norwegian study,[19] 610 patients undergoing coronary artery bypass grafting were randomized either to a fish oil group (4 g/day) or to a control group. The primary end point was graft patency at 1 year, which was assessed by angiography. Vein graft occlusion rates were 27% in the fish oil group and 33% in the control group (odds ratio, 0.77; 95% CI, 0.60-0.99; p=0.034). It was also noted that there was an inverse relation between relative changes in serum n-3 PUFA levels and vein graft occlusion.

In another more recent angiographic randomized controlled trial,[20] 223 patients with angiographically proven CHD were randomized to fish oil capsules or a control group with capsules containing fatty acids resembling those in the average European diet. Results showed that n-3 PUFAs had a modest mitigating effect on CHD progression as measured angiographically.

Clinical trials in angioplasty patients have generally not demonstrated a benefit from n-3 PUFA supplementation. Although there have been some trials that are exceptions, the larger high-quality trials have not shown a benefit. A recent randomized trial[21] with 500 elective coronary angioplasty patients compared treatment with fish-derived n-3 PUFA capsules (5 g/day) with a control group receiving corn oil capsules (5 g/day). N-3 PUFA or corn oil was started 2 weeks before angioplasty and continued until evaluation by angiography at 6 months. Restenosis occurred in 40.6% of the n-3 PUFA group and 35.4% of the placebo group (odds ratio, 1.25; 95% CI, 0.87-1.80; p=0.21). On balance, the n-3 PUFAs do not appear to prevent the high rate of restenosis experienced after angioplasty.[21]

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