High dose Omega-3 probably reduces heart problems – American Heart Association – March 2017

Omega-3 Polyunsaturated Fatty Acid (Fish Oil) Supplementation and the Prevention of Clinical Cardiovascular Disease: A Science Advisory From the American Heart Association

Circulation. 2017; https://doi.org/10.1161/CIR.0000000000000482, published March 13, 2017
David S. Siscovick, Thomas A. Barringer, Amanda M. Fretts, Jason H.Y. Wu, Alice H. Lichtenstein, Rebecca B. Costello, Penny M. Kris-Etherton, Terry A. Jacobson, Mary B. Engler, Heather M. Alger, Lawrence J. Appel, Dariush Mozaffarian, On behalf of the American Heart Association Nutrition Committee of the Council on Lifestyle and Cardiometabolic Health; Council on Epidemiology and Prevention; Council on Cardiovascular Disease in the Young; Council on Cardiovascular and Stroke Nursing; and Council on Clinical Cardiology

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Conclusions (from PDF)

Although recent RCT evidence has raised questions
about the benefits of omega-3 supplementation to prevent
clinical CVD events, the recommendation for patients
with prevalent CHD such as a recent MI remains
essentially unchanged: Treatment with omega-3 PUFA
supplements is reasonable for these patients. Even a
potential modest reduction in CHD mortality (10%) in
this clinical population would justify treatment with a
relatively safe therapy. We now recommend treatment
for patients with prevalent heart failure without preserved
left ventricular function to reduce mortality and
hospitalizations (9%) on the basis of a single, large RCT.
Although we do not recommend treatment for patients
with diabetes mellitus and prediabetes to prevent CHD,
there was a lack of consensus on the recommendation
for patients at high CVD risk. On the other hand, we
do not recommend treatment to prevent incident stroke
among patients at high CVD risk and recurrent AF. Because
there are no reported RCTs related to the primary
prevention of CHD, heart failure, and AF, we were not
able to make recommendations for these indications.
RCTs in progress with clinical CVD end points may inform
recommendations related to these potential indications
for omega-3 PUFA supplementation.

Abstract

Multiple randomized controlled trials (RCTs) have assessed the effects of supplementation with eicosapentaenoic acid plus docosahexaenoic acid (omega-3 polyunsaturated fatty acids, commonly called fish oils) on the occurrence of clinical cardiovascular diseases. Although the effects of supplementation for the primary prevention of clinical cardiovascular events in the general population have not been examined, RCTs have assessed the role of supplementation in secondary prevention among patients with diabetes mellitus and prediabetes, patients at high risk of cardiovascular disease, and those with prevalent coronary heart disease. In this scientific advisory, we take a clinical approach and focus on common indications for omega-3 polyunsaturated fatty acid supplements related to the prevention of clinical cardiovascular events. We limited the scope of our review to large RCTs of supplementation with major clinical cardiovascular disease end points; meta-analyses were considered secondarily. We discuss the features of available RCTs and provide the rationale for our recommendations. We then use existing American Heart Association criteria to assess the strength of the recommendation and the level of evidence. On the basis of our review of the cumulative evidence from RCTs designed to assess the effect of omega-3 polyunsaturated fatty acid supplementation on clinical cardiovascular events, we update prior recommendations for patients with prevalent coronary heart disease, and we offer recommendations, when data are available, for patients with other clinical indications, including patients with diabetes mellitus and prediabetes and those with high risk of cardiovascular disease, stroke, heart failure, and atrial fibrillation.