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Effect of fish oil on arrhythmias and mortality: systematic review.

León H, Shibata MC, Sivakumaran S, Dorgan M, Chatterley T, Tsuyuki RT - BMJ (2008)

Bottom Line: The dose-response relation for DHA and EPA on reduction in deaths from cardiac causes was not significant.Fish oil supplementation was associated with a significant reduction in deaths from cardiac causes but had no effect on arrhythmias or all cause mortality.Evidence to recommend an optimal formulation of EPA or DHA to reduce these outcomes is insufficient.

View Article: PubMed Central - PubMed

Affiliation: Epidemiology Coordinating and Research (EPICORE) Centre, Edmonton, AB, Canada.

ABSTRACT

Objective: To synthesise the literature on the effects of fish oil-docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA)-on mortality and arrhythmias and to explore dose response and formulation effects.

Design: Systematic review and meta-analysis.

Data sources: Medline, Embase, the Cochrane Library, PubMed, CINAHL, IPA, Web of Science, Scopus, Pascal, Allied and Complementary Medicine, Academic OneFile, ProQuest Dissertations and Theses, Evidence-Based Complementary Medicine, and LILACS. Studies reviewed Randomised controlled trials of fish oil as dietary supplements in humans.

Data extraction: The primary outcomes of interest were the arrhythmic end points of appropriate implantable cardiac defibrillator intervention and sudden cardiac death. The secondary outcomes were all cause mortality and death from cardiac causes. Subgroup analyses included the effect of formulations of EPA and DHA on death from cardiac causes and effects of fish oil in patients with coronary artery disease or myocardial infarction.

Data synthesis: 12 studies totalling 32 779 patients met the inclusion criteria. A neutral effect was reported in three studies (n=1148) for appropriate implantable cardiac defibrillator intervention (odds ratio 0.90, 95% confidence interval 0.55 to 1.46) and in six studies (n=31 111) for sudden cardiac death (0.81, 0.52 to 1.25). 11 studies (n=32 439 and n=32 519) provided data on the effects of fish oil on all cause mortality (0.92, 0.82 to 1.03) and a reduction in deaths from cardiac causes (0.80, 0.69 to 0.92). The dose-response relation for DHA and EPA on reduction in deaths from cardiac causes was not significant.

Conclusions: Fish oil supplementation was associated with a significant reduction in deaths from cardiac causes but had no effect on arrhythmias or all cause mortality. Evidence to recommend an optimal formulation of EPA or DHA to reduce these outcomes is insufficient. Fish oils are a heterogeneous product, and the optimal formulations for DHA and EPA remain unclear.

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Fig 6 Effect of fish oil on sudden cardiac death and death from cardiac causes in patients with coronary artery disease
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fig6: Fig 6 Effect of fish oil on sudden cardiac death and death from cardiac causes in patients with coronary artery disease

Mentions: A subgroup analysis was done on the effect of fish oil on sudden cardiac death and death from cardiac causes in patients with coronary artery disease or after myocardial infarction, including the secondary prevention arm of the JELIS trial.w5 Four studies that included 15 528 patients showed a 26% reduction (0.74, 0.59 to 0.92) in sudden cardiac death with fish oil (fig 6). Eight studies with 16 390 patients showed a significant 20% reduction in deaths from cardiac causes compared with placebo (0.80, 0.69 to 0.93) in patients with coronary artery disease or after myocardial infarction (fig 6).


Effect of fish oil on arrhythmias and mortality: systematic review.

León H, Shibata MC, Sivakumaran S, Dorgan M, Chatterley T, Tsuyuki RT - BMJ (2008)

Fig 6 Effect of fish oil on sudden cardiac death and death from cardiac causes in patients with coronary artery disease
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2612582&req=5

fig6: Fig 6 Effect of fish oil on sudden cardiac death and death from cardiac causes in patients with coronary artery disease
Mentions: A subgroup analysis was done on the effect of fish oil on sudden cardiac death and death from cardiac causes in patients with coronary artery disease or after myocardial infarction, including the secondary prevention arm of the JELIS trial.w5 Four studies that included 15 528 patients showed a 26% reduction (0.74, 0.59 to 0.92) in sudden cardiac death with fish oil (fig 6). Eight studies with 16 390 patients showed a significant 20% reduction in deaths from cardiac causes compared with placebo (0.80, 0.69 to 0.93) in patients with coronary artery disease or after myocardial infarction (fig 6).

Bottom Line: The dose-response relation for DHA and EPA on reduction in deaths from cardiac causes was not significant.Fish oil supplementation was associated with a significant reduction in deaths from cardiac causes but had no effect on arrhythmias or all cause mortality.Evidence to recommend an optimal formulation of EPA or DHA to reduce these outcomes is insufficient.

View Article: PubMed Central - PubMed

Affiliation: Epidemiology Coordinating and Research (EPICORE) Centre, Edmonton, AB, Canada.

ABSTRACT

Objective: To synthesise the literature on the effects of fish oil-docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA)-on mortality and arrhythmias and to explore dose response and formulation effects.

Design: Systematic review and meta-analysis.

Data sources: Medline, Embase, the Cochrane Library, PubMed, CINAHL, IPA, Web of Science, Scopus, Pascal, Allied and Complementary Medicine, Academic OneFile, ProQuest Dissertations and Theses, Evidence-Based Complementary Medicine, and LILACS. Studies reviewed Randomised controlled trials of fish oil as dietary supplements in humans.

Data extraction: The primary outcomes of interest were the arrhythmic end points of appropriate implantable cardiac defibrillator intervention and sudden cardiac death. The secondary outcomes were all cause mortality and death from cardiac causes. Subgroup analyses included the effect of formulations of EPA and DHA on death from cardiac causes and effects of fish oil in patients with coronary artery disease or myocardial infarction.

Data synthesis: 12 studies totalling 32 779 patients met the inclusion criteria. A neutral effect was reported in three studies (n=1148) for appropriate implantable cardiac defibrillator intervention (odds ratio 0.90, 95% confidence interval 0.55 to 1.46) and in six studies (n=31 111) for sudden cardiac death (0.81, 0.52 to 1.25). 11 studies (n=32 439 and n=32 519) provided data on the effects of fish oil on all cause mortality (0.92, 0.82 to 1.03) and a reduction in deaths from cardiac causes (0.80, 0.69 to 0.92). The dose-response relation for DHA and EPA on reduction in deaths from cardiac causes was not significant.

Conclusions: Fish oil supplementation was associated with a significant reduction in deaths from cardiac causes but had no effect on arrhythmias or all cause mortality. Evidence to recommend an optimal formulation of EPA or DHA to reduce these outcomes is insufficient. Fish oils are a heterogeneous product, and the optimal formulations for DHA and EPA remain unclear.

Show MeSH
Related in: MedlinePlus