Intervention Review

Omega 3 fatty acids for prevention and treatment of cardiovascular disease

  1. Lee Hooper1,*,
  2. Roger A Harrison2,
  3. Carolyn D Summerbell3,
  4. Helen Moore3,
  5. Helen V Worthington4,
  6. Andrew Ness5,
  7. Nigel Capps6,
  8. George Davey Smith7,
  9. Rudolph Riemersma8,
  10. Shah Ebrahim9

Editorial Group: Cochrane Heart Group

Published Online: 21 JAN 2009

Assessed as up-to-date: 31 JUL 2004

DOI: 10.1002/14651858.CD003177.pub2

Database Title

Additional Information

How to Cite

Hooper L, Harrison RA, Summerbell CD, Moore H, Worthington HV, Ness A, Capps N, Davey Smith G, Riemersma R, Ebrahim S. Omega 3 fatty acids for prevention and treatment of cardiovascular disease. Cochrane Database of Systematic Reviews 2004, Issue 4. Art. No.: CD003177. DOI: 10.1002/14651858.CD003177.pub2.

Author Information

  1. 1

    University of East Anglia, School of Medicine, Health Policy & Practice, Norwich, UK

  2. 2

    University of Manchester, Division of Epidemiology and Health Sciences, Manchester, UK

  3. 3

    University of Teesside, School of Health and Social Care, Middlesbrough, Teesside, UK

  4. 4

    School of Dentistry, The University of Manchester, Cochrane Oral Health Group, MANDEC, Manchester, UK

  5. 5

    Department of Social Medicine, Bristol, Avon, UK

  6. 6

    Royal Princess Hospital NHS Trust, Department of Clinical Biochemistry, Telford, UK

  7. 7

    University of Bristol, Department of Social Medicine, Bristol, UK

  8. 8

    University of Edinburgh, Department of Medicine, Cardiovascular Research Unit, Edinburgh, UK

  9. 9

    London School of Hygiene & Tropical Medicine, Department of Epidemiology & Population Health, London, UK

*Lee Hooper, School of Medicine, Health Policy & Practice, University of East Anglia, Norwich, NR4 7TJ, UK. l.hooper@uea.ac.uk.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 21 JAN 2009

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

It has been suggested that omega 3 (W3, n-3 or omega-3) fats from oily fish and plants are beneficial to health.

Objectives

To assess whether dietary or supplemental omega 3 fatty acids alter total mortality, cardiovascular events or cancers using both RCT and cohort studies.

Search methods

Five databases including CENTRAL, MEDLINE and EMBASE were searched to February 2002. No language restrictions were applied. Bibliographies were checked and authors contacted.

Selection criteria

RCTs were included where omega 3 intake or advice was randomly allocated and unconfounded, and study duration was at least six months. Cohorts were included where a cohort was followed up for at least six months and omega 3 intake estimated.

Data collection and analysis

Studies were assessed for inclusion, data extracted and quality assessed independently in duplicate. Random effects meta-analysis was performed separately for RCT and cohort data.

Main results

Forty eight randomised controlled trials (36,913 participants) and 41 cohort analyses were included. Pooled trial results did not show a reduction in the risk of total mortality or combined cardiovascular events in those taking additional omega 3 fats (with significant statistical heterogeneity). Sensitivity analysis, retaining only studies at low risk of bias, reduced heterogeneity and again suggested no significant effect of omega 3 fats.

Restricting analysis to trials increasing fish-based omega 3 fats, or those increasing short chain omega 3s, did not suggest significant effects on mortality or cardiovascular events in either group. Subgroup analysis by dietary advice or supplementation, baseline risk of CVD or omega 3 dose suggested no clear effects of these factors on primary outcomes.

Neither RCTs nor cohorts suggested increased relative risk of cancers with higher omega 3 intake but estimates were imprecise so a clinically important effect could not be excluded.

Authors' conclusions

It is not clear that dietary or supplemental omega 3 fats alter total mortality, combined cardiovascular events or cancers in people with, or at high risk of, cardiovascular disease or in the general population. There is no evidence we should advise people to stop taking rich sources of omega 3 fats, but further high quality trials are needed to confirm suggestions of a protective effect of omega 3 fats on cardiovascular health.

There is no clear evidence that omega 3 fats differ in effectiveness according to fish or plant sources, dietary or supplemental sources, dose or presence of placebo.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

There is not enough evidence to say that people should stop taking rich sources of omega 3 fats, but further high quality trials are needed to confirm the previously suggested protective effect of omega 3 fats for those at increased cardiovascular risk

The review shows that it is not clear whether dietary or supplemental omega 3 fats (found in oily fish and some vegetable oils) alter total deaths, cardiovascular events (such as heart attacks and strokes) or cancers in the general population, or in people at risk of, or with, cardiovascular disease. When the analysis was limited to fish-based or plant-based, dietary or supplemental omega 3 fats there was still no evidence of reduction in deaths or cardiovascular events in any group.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

歐米加3脂肪酸用於預防及治療心血管疾病

目前認為來自多油的魚類和植物的歐米加3(W3, n3或歐米加−3)脂類對健康有益。

目標

以隨機分配試驗及世代研究來評估飲食中或補充的歐米加3脂肪酸是否可以改變總死亡率、心血管事件或癌症的機率。

搜尋策略

搜尋包含CENTRAL、MEDLINE和EMBASE在內的五個資料庫，時間到2002年2月。沒有施行語言的限制。參考文獻也進行查核並聯絡作者。

選擇標準

對歐米加3的攝取或建議進行隨機分派且除去干擾因素之隨機分配試驗，試驗期間至少6個月。需追蹤至少6個月的世代研究才涵刮在內，並進行歐米加3攝取量的預估。

資料收集與分析

對試驗進行加入及資料擷取的評估，試驗品質則獨立地評估兩次。分別對隨機分配試驗及世代研究的資料進行統合分析。

主要結論

共涵括48個隨機分配試驗(36,913個參加者)和41個世代分析。試驗的集合結果並無法顯示額外攝取歐米加3脂類者可減少總死亡率或合併的心血管事件之風險(具有顯著的統計上異質性)。敏感性分析僅涵刮那些偏差風險低的試驗，可減少異質性但仍舊暗示歐米加3脂類沒有顯著效果。將分析的範圍侷限於魚類來的歐米加3脂類或短鏈歐米加3脂類量較高的試驗仍無法顯示這兩者對死亡率或心血管事件有顯著影響。飲食建議或額外補充、心血管疾病的基準風險或歐米加3脂類劑量的次族群分析顯示這些因素對主要終點沒有明確的影響。歐米加3脂類攝取量高者的隨機分配試驗或世代研究都沒有顯示會增加癌症的相對風險，但因為劑量的估計並不準確，所以無法排除對臨床有重要影響。

作者結論

目前並不清楚飲食中或額外補充歐米加3脂類對於已患有或罹患心血管疾病風險高者或一般人口是否可以降低總死亡率、合併的心血管事件或癌症的風險。目前沒有證據顯示吾人應建議民眾停止攝取富含歐米加3脂類來源的物質，但需要更進一步的高品質試驗來確定歐米加3脂類對心血管健康有保護性效果。目前沒有明確證據顯示不同來源(魚類或植物)、不同補充方式(飲食中或額外補充)、不同劑量或是否有安慰劑做比較對於歐米加3脂類的效果有影響。

翻譯人

本摘要由臺北榮民總醫院陳國維翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

目前沒有足夠的證據可以支持民眾應該停止攝取富含歐米加3脂類來源的物質，但需要進一步高品質的試驗來確認原先認為對心血管疾病風險較高者歐米加3脂類所具有的保護效果。此分析無法顯示對於一般人口、具有心血管疾病風險者或患有心血管疾病者，飲食中或額外補充歐米加3脂類(含油量高的魚類及某些植物油)可以改變總死亡率、心血管事件(如心臟病發與中風)或癌症的機率。即使將分析侷限於下列族群(魚類來源或植物來源、飲食中或額外補充的歐米加3脂類)，仍舊顯示沒有任何一組可以降低死亡或心血管事件。

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