Comparative efficacy of omega-3 polyunsaturated fatty acids on major cardiovascular events: A network meta-analysis of randomized controlled trials

Bo Yang; Ping-Tao Tseng; Xiang Hu; Bing-Yan Zeng; Jane Pei-Chen Chang; Yang Liu; Wei-Jie Chu; Shuang-Shuang Zhang; Zhi-Liang Zhou; Chih-Sheng Chu; Cheng-Ho Chang; Yu-Kang Tu; Yi-Cheng Wu; Brendon Stubbs; Andre F Carvalho; Pao-Yen Lin; Yutaka J Matsuoka; Mein-Woei Suen; Kuan-Pin Su

doi:10.1016/j.plipres.2022.101196

Comparative efficacy of omega-3 polyunsaturated fatty acids on major cardiovascular events: A network meta-analysis of randomized controlled trials

Prog Lipid Res. 2022 Nov:88:101196. doi: 10.1016/j.plipres.2022.101196. Epub 2022 Oct 28.

Authors

Bo Yang¹, Ping-Tao Tseng², Xiang Hu³, Bing-Yan Zeng⁴, Jane Pei-Chen Chang⁵, Yang Liu⁶, Wei-Jie Chu⁶, Shuang-Shuang Zhang⁶, Zhi-Liang Zhou⁷, Chih-Sheng Chu⁸, Cheng-Ho Chang⁹, Yu-Kang Tu¹⁰, Yi-Cheng Wu¹¹, Brendon Stubbs¹², Andre F Carvalho¹³, Pao-Yen Lin¹⁴, Yutaka J Matsuoka¹⁵, Mein-Woei Suen¹⁶, Kuan-Pin Su¹⁷

Affiliations

¹ School of Public Health and Management & Institute of Lipids Medicine, Wenzhou Medical University, Wenzhou, China; Department of Psychiatry & Mind-Body Interface Laboratory (MBI-Lab), China Medical University Hospital, Taichung, Taiwan.
² Department of Psychology, College of Medical and Health Science, Asia University, Taichung, Taiwan; Prospect Clinic for Otorhinolaryngology & Neurology, Kaohsiung City, Taiwan; Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan; Institute of Precision Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan.
³ The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
⁴ Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan; Department of Internal Medicine, E-Da Dachang Hospital, Kaohsiung, Taiwan.
⁵ Department of Psychiatry & Mind-Body Interface Laboratory (MBI-Lab), China Medical University Hospital, Taichung, Taiwan; Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; College of Medicine, China Medical University, Taichung, Taiwan.
⁶ School of Public Health and Management & Institute of Lipids Medicine, Wenzhou Medical University, Wenzhou, China.
⁷ The 2nd Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China.
⁸ Center of Lipid Bioscience, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
⁹ Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Department of Food Science, National Pingtung University of Science and Technology, Pingtung, Taiwan.
¹⁰ Institute of Epidemiology & Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan; Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan.
¹¹ Department of Sports Medicine, Landseed International Hospital, Taoyuan, Taiwan.
¹² Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK; Positive Ageing Research Institute (PARI), Faculty of Health, Social Care, Medicine and Education, Anglia Ruskin University, Chelmsford, UK.
¹³ Innovation in Mental and Physical Health and Clinical Treatment (IMPACT) Strategic Research Centre, School of Medicine, Barwon Health, Deakin University, Geelong, VIC, Australia.
¹⁴ Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; Institute for Translational Research in Biomedical Sciences, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
¹⁵ Former Division Chief of Health Care Research, National Cancer Centre Japan, Japan.
¹⁶ Department of Psychology, College of Medical and Health Science, Asia University, Taichung, Taiwan; Gender Equality Education and Research Center, Asia University, Taichung, Taiwan; Department of Medical Research, Asia University Hospital, Asia University, Taichung, Taiwan; Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan.
¹⁷ School of Public Health and Management & Institute of Lipids Medicine, Wenzhou Medical University, Wenzhou, China; Department of Psychiatry & Mind-Body Interface Laboratory (MBI-Lab), China Medical University Hospital, Taichung, Taiwan; College of Medicine, China Medical University, Taichung, Taiwan; An-Nan Hospital, China Medical University, Tainan, Taiwan. Electronic address: cobolsu@gmail.com.

PMID: 36341839
DOI: 10.1016/j.plipres.2022.101196

Abstract

The role of omega-3 polyunsaturated fatty acids (PUFAs) in primary and secondary prevention on major cardiovascular events (MCE) is inconclusive due to the potential heterogeneity in study designs of formulas, dosages, and ratios of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) from the findings of previous randomized controlled trials (RCTs). Here we conducted a comprehensive narrative review of pre-clinical studies and updated a network meta-analysis (NMA) to determine the comparative efficacy against MCE with different EPA/DHA dosages and formulas. We found that pure EPA was ranked the best option in the secondary prevention (hazard ratio: 0.72, 95% confidence interval: 0.65 to 0.81) from the NMA of 39 RCTs with 88,359 participants. There was no evidence of omega-3 PUFAs' efficacy in primary prevention. The mechanisms of omega-3 PUFAs' cardiovascular protection might link to the effects of anti-inflammation and stabilization of endothelial function from PUFA's derivatives including eicosanoids and the special pre-resolving mediators (SPMs).

Keywords: Cardiovascular disease; Major cardiovascular events; Network meta-analysis; Omega-3.

Publication types

Meta-Analysis
Review
Research Support, Non-U.S. Gov't

MeSH terms

Cardiovascular Diseases* / drug therapy
Cardiovascular Diseases* / prevention & control
Docosahexaenoic Acids / pharmacology
Docosahexaenoic Acids / therapeutic use
Eicosapentaenoic Acid / pharmacology
Fatty Acids, Omega-3* / pharmacology
Fatty Acids, Omega-3* / therapeutic use
Humans
Network Meta-Analysis
Randomized Controlled Trials as Topic
Treatment Outcome

Substances

Fatty Acids, Omega-3
Eicosapentaenoic Acid
Docosahexaenoic Acids