N-3 polyunsaturated fatty acids in coronary heart disease: a meta-analysis of randomized controlled trials

Purpose Observational studies have shown an inconsistent association between n-3 polyunsaturated fatty acids and the risk of coronary heart disease. We investigated the effects of dietary and nondietary (supplemental) intake of n-3 polyunsaturated fatty acids on coronary heart disease. Subjects and methods We searched the literature to identify randomized controlled trials that compared dietary or nondietary intake of n-3 polyunsaturated fatty acids with a control diet or placebo in patients with coronary heart disease. Studies had to have at least 6 months of follow-up data, and to have reported clinical endpoint data. We identified 11 trials, published between 1966 and 1999, which included 7951 patients in the intervention and 7855 patients in the control groups. Results The risk ratio of nonfatal myocardial infarction in patients who were on n-3 polyunsaturated fatty acid-enriched diets compared with control diets or placebo was 0.8 (95% confidence interval [CI]: 0.5 to 1.2, P = 0.16; Breslow-Day test for heterogeneity, P = 0.01), and the risk ratio of fatal myocardial infarction was 0.7 (95% CI: 0.6 to 0.8, P<0.001; heterogeneity P>0.20). In 5 trials, sudden death was associated with a risk ratio of 0.7 (95% CI: 0.6 to 0.9, P<0.01; heterogeneity P>0.20), whereas the risk ratio of overall mortality was 0.8 (95% CI: 0.7 to 0.9, P<0.001; heterogeneity P>0.20). There was no difference in summary estimates between dietary and nondietary interventions of n-3 polyunsaturated fatty acids for all endpoints. Conclusion This meta-analysis suggests that dietary and nondietary intake of n-3 polyunsaturated fatty acids reduces overall mortality, mortality due to myocardial infarction, and sudden death in patients with coronary heart disease.