2012 meta analysis: Omega-3s & heart disease

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2012 meta analysis: Omega-3s & heart disease

Postby jimmylegs » Fri Sep 14, 2018 10:34 am

Association Between Omega-3 Fatty Acid Supplementation and Risk of Major Cardiovascular Disease Events - A Systematic Review and Meta-analysis (2012)
https://jamanetwork.com/journals/jama/a ... .2018.2498

Abstract
Context Considerable controversy exists regarding the association of omega-3 polyunsaturated fatty acids (PUFAs) and major cardiovascular end points.

Objective To assess the role of omega-3 supplementation on major cardiovascular outcomes.

Data Sources MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials through August 2012.

Study Selection Randomized clinical trials evaluating the effect of omega-3 on all-cause mortality, cardiac death, sudden death, myocardial infarction, and stroke.

Data Extraction Descriptive and quantitative information was extracted; absolute and relative risk (RR) estimates were synthesized under a random-effects model. Heterogeneity was assessed using the Q statistic and I2. Subgroup analyses were performed for the presence of blinding, the prevention settings, and patients with implantable cardioverter-defibrillators, and meta-regression analyses were performed for the omega-3 dose. A statistical significance threshold of .0063 was assumed after adjustment for multiple comparisons.

Data Synthesis Of the 3635 citations retrieved, 20 studies of 68 680 patients were included, reporting 7044 deaths, 3993 cardiac deaths, 1150 sudden deaths, 1837 myocardial infarctions, and 1490 strokes. No statistically significant association was observed with all-cause mortality (RR, 0.96; 95% CI, 0.91 to 1.02; risk reduction [RD] −0.004, 95% CI, −0.01 to 0.02), cardiac death (RR, 0.91; 95% CI, 0.85 to 0.98; RD, −0.01; 95% CI, −0.02 to 0.00), sudden death (RR, 0.87; 95% CI, 0.75 to 1.01; RD, −0.003; 95% CI, −0.012 to 0.006), myocardial infarction (RR, 0.89; 95% CI, 0.76 to 1.04; RD, −0.002; 95% CI, −0.007 to 0.002), and stroke (RR, 1.05; 95% CI, 0.93 to 1.18; RD, 0.001; 95% CI, −0.002 to 0.004) when all supplement studies were considered.

Conclusion Overall, omega-3 PUFA supplementation was not associated with a lower risk of all-cause mortality, cardiac death, sudden death, myocardial infarction, or stroke based on relative and absolute measures of association.

maybe they should have re-worked the title...

would need to dig in to full text to find out how they assessed supplementation and whether they looked at total intake (doesn't sound like it)
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Re: 2012 meta analysis: Omega-3s & heart disease

Postby jimmylegs » Fri Sep 14, 2018 10:39 am

Seafood Long-Chain n-3 Polyunsaturated Fatty Acids and Cardiovascular Disease: A Science Advisory From the American Heart Association (2018)
https://www.ahajournals.org/doi/abs/10. ... 0000000574

Abstract
Since the 2002 American Heart Association scientific statement “Fish Consumption, Fish Oil, Omega-3 Fatty Acids, and Cardiovascular Disease,” evidence from observational and experimental studies and from randomized controlled trials continues to emerge to further substantiate the beneficial effects of seafood long-chain n-3 polyunsaturated fatty acids and cardiovascular disease. A recent American Heart Association science advisory addressed the specific effect of n-3 polyunsaturated fatty acid supplementation on clinical cardiovascular events. This American Heart Association science advisory extends that review and offers further support to include n-3 polyunsaturated fatty acids from seafood consumption. Several potential mechanisms have been investigated, including antiarrhythmic, anti-inflammatory, hematologic, and endothelial, although for most, longer-term dietary trials of seafood are warranted to substantiate the benefit of seafood as a replacement for other important sources of macronutrients. The present science advisory reviews this evidence and makes a suggestion in the context of the 2015–2020 Dietary Guidelines for Americans and in consideration of other constituents of seafood and the impact on sustainability. We conclude that 1 to 2 seafood meals per week be included to reduce the risk of congestive heart failure, coronary heart disease, ischemic stroke, and sudden cardiac death, especially when seafood replaces the intake of less healthy foods.

dammit can't just put seafood *on* the doritos? (KIDDING - i never eat that kind of pseudo food)
take control of your own health
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ask for referrals to preventive health care specialists eg dietitians
don't let suboptimal self care muddy any underlying diagnostic picture!
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Re: 2012 meta analysis: Omega-3s & heart disease

Postby jimmylegs » Sat Sep 15, 2018 7:10 am

Associations of Omega-3 Fatty Acid Supplement Use With Cardiovascular Disease Risks - Meta-analysis of 10 Trials Involving 77 917 Individuals (2018)
https://jamanetwork.com/journals/jamaca ... 81015207=1

"Key Points
Question Does supplementation with marine-derived omega-3 fatty acids have any associations with reductions in fatal or nonfatal coronary heart disease in people at high risk of cardiovascular disease?

Findings This meta-analysis of 10 trials involving 77 917 participants demonstrated that supplementation with marine-derived omega-3 fatty acids for a mean of 4.4 years had no significant association with reductions in fatal or nonfatal coronary heart disease or any major vascular events.

Meaning The results provide no support for current recommendations to use omega-3 fatty acid supplements for the prevention of fatal coronary heart disease or any cardiovascular disease in people who have or at high risk of developing cardiovascular disease.

Abstract
Importance Current guidelines advocate the use of marine-derived omega-3 fatty acids supplements for the prevention of coronary heart disease and major vascular events in people with prior coronary heart disease, but large trials of omega-3 fatty acids have produced conflicting results.

Objective To conduct a meta-analysis of all large trials assessing the associations of omega-3 fatty acid supplements with the risk of fatal and nonfatal coronary heart disease and major vascular events in the full study population and prespecified subgroups.

Data Sources and Study Selection This meta-analysis included randomized trials that involved at least 500 participants and a treatment duration of at least 1 year and that assessed associations of omega-3 fatty acids with the risk of vascular events.

Data Extraction and Synthesis Aggregated study-level data were obtained from 10 large randomized clinical trials. Rate ratios for each trial were synthesized using observed minus expected statistics and variances. Summary rate ratios were estimated by a fixed-effects meta-analysis using 95% confidence intervals for major diseases and 99% confidence intervals for all subgroups.

Main Outcomes and Measures The main outcomes included fatal coronary heart disease, nonfatal myocardial infarction, stroke, major vascular events, and all-cause mortality, as well as major vascular events in study population subgroups.

Results Of the 77 917 high-risk individuals participating in the 10 trials, 47 803 (61.4%) were men, and the mean age at entry was 64.0 years; the trials lasted a mean of 4.4 years. The associations of treatment with outcomes were assessed on 6273 coronary heart disease events (2695 coronary heart disease deaths and 2276 nonfatal myocardial infarctions) and 12 001 major vascular events. Randomization to omega-3 fatty acid supplementation (eicosapentaenoic acid dose range, 226-1800 mg/d) had no significant associations with coronary heart disease death (rate ratio [RR], 0.93; 99% CI, 0.83-1.03; P = .05), nonfatal myocardial infarction (RR, 0.97; 99% CI, 0.87-1.08; P = .43) or any coronary heart disease events (RR, 0.96; 95% CI, 0.90-1.01; P = .12). Neither did randomization to omega-3 fatty acid supplementation have any significant associations with major vascular events (RR, 0.97; 95% CI, 0.93-1.01; P = .10), overall or in any subgroups, including subgroups composed of persons with prior coronary heart disease, diabetes, lipid levels greater than a given cutoff level, or statin use.

Conclusions and Relevance This meta-analysis demonstrated that omega-3 fatty acids had no significant association with fatal or nonfatal coronary heart disease or any major vascular events. It provides no support for current recommendations for the use of such supplements in people with a history of coronary heart disease."

i'm searching using very vague search terms. since the research seems to be zeroed in on cardiovascular issues, i wonder what else if anything could stand to be examined.
perhaps, again, not just supplementation but total intakes. not just 4.4 years. i don't have time to really dig in but am curious
take control of your own health
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don't let suboptimal self care muddy any underlying diagnostic picture!
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Re: 2012 meta analysis: Omega-3s & heart disease

Postby ElliotB » Sat Sep 15, 2018 7:19 am

'Conclusion: omega-3 fatty acids had no significant association with fatal or nonfatal coronary heart disease or any major vascular events'


Not everyone would agree with their conclusion (see link below for a cardiologists perspective).

Also consider that there are different types of Omega 3 fatty acids (primarily EPA and DHA) and for heart health, Omega 3 with higher levels of DHA than EPA may be a better choice (most Omega 3 supplements have higher levels of EPA than DHA).

Another potentially very important consideration, there are numerous sources of Omega 3 fatty acids and this study does not seem to take that into account either (some are considered better than others). It is possible/likely that the source of the Omega 3 fatty acids could have an effect on the effectiveness of it and ultimately effect the results.


A lot of good info here:

Cardiovascular Benefits of Omega-3 Fatty Acids

https://www.drsinatra.com/enjoy-DHA-omega-3-benefits
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Re: 2012 meta analysis: Omega-3s & heart disease

Postby jimmylegs » Sat Sep 15, 2018 7:33 am

isn't it nice that i don't make you click and sift through who knows what to access my point?

without taking the clickbait above, i wonder what n is represented by 'not everyone' 's opinion?

from the studies above, the other position is at n = 68 680 + 77 917 = 146,597 and counting (see how i did the math for you ;) ).
take control of your own health
pursue optimal self care at least as actively as a diagnosis
ask for referrals to preventive health care specialists eg dietitians
don't let suboptimal self care muddy any underlying diagnostic picture!
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Re: 2012 meta analysis: Omega-3s & heart disease

Postby ElliotB » Sat Sep 15, 2018 8:15 am

There are so many dissenting opinions on the conclusion of this study on the web, too many to list. So to summarize Dr. Sinatra's opinion, the conclusion of the study is totally wrong.

For anyone interested, simply type
"Are omega 3 fatty acids good for heart health"
in your Dr. Google search engine for almost 19 million results
with a variety of opinions, many contrary to the conclusion of the study.

Of course, you can always also try a search for opposing views by typing:
"are omega 3 fatty acids bad for heart health"

According to this article:
https://www.sciencedaily.com/releases/2 ... 194558.htm
"Omega 3 supplements have little or no heart or vascular health benefit'

As with the study you posted, there is no information on the type or characteristics of the Omega 3 used.


AND As with every topic, there are always differences of opinion and I have learned never to trust 1 source. And one thing is for sure, clinical trials are easy to manipulate to skew the results based on the result the sponsor wants and I always seek additional opinions. And of course just because something is found on the web, does not mean it is accurate.

From a source you like to rely on, The Harvard Medical School, their conclusion:

"Omega-3s and your heart
There are three main forms of these unsaturated fats, which play an essential role in human health (see "Three key omega-3s"). The so-called marine fatty acids, EPA and DHA, have several potential cardiovascular benefits. They might help

ease inflammation

ensure the heart maintains a steady beat, which may guard against potentially deadly, erratic rhythms

prevent the formation of dangerous clots in the bloodstream

lower levels of triglycerides, the most common type of fat-carrying particle in the bloodstream."


Here is a link to the complete Harvard article:
https://www.health.harvard.edu/heart-he ... et-deliver



My conclusion: The vast majority of opinions/research on this topic is contrary to the conclusion of the study. That does not mean that the study is wrong, but it is likely we just cannot determine the results of what Omega 3s can do with certainty at this time.
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Re: 2012 meta analysis: Omega-3s & heart disease

Postby jimmylegs » Sat Sep 15, 2018 8:22 am

better :)
take control of your own health
pursue optimal self care at least as actively as a diagnosis
ask for referrals to preventive health care specialists eg dietitians
don't let suboptimal self care muddy any underlying diagnostic picture!
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Re: 2012 meta analysis: Omega-3s & heart disease

Postby NHE » Sat Sep 15, 2018 11:57 pm

jimmylegs wrote:Conclusions and Relevance This meta-analysis demonstrated that omega-3 fatty acids had no significant association with fatal or nonfatal coronary heart disease or any major vascular events. It provides no support for current recommendations for the use of such supplements in people with a history of coronary heart disease."

It doesn't matter. I have less fatigue and more cognitive energy when I take my fish oil.
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Re: 2012 meta analysis: Omega-3s & heart disease

Postby jimmylegs » Sun Sep 16, 2018 4:13 am

jimmylegs wrote:i'm searching using very vague search terms. since the research seems to be zeroed in on cardiovascular issues, i wonder what else if anything could stand to be examined.

perhaps, again, not just supplementation but total intakes. not just 4.4 years. i don't have time to really dig in but am curious
yep
take control of your own health
pursue optimal self care at least as actively as a diagnosis
ask for referrals to preventive health care specialists eg dietitians
don't let suboptimal self care muddy any underlying diagnostic picture!
User avatar
jimmylegs
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