A Meta-Analysis of Randomized Controlled Trials and Prospective Cohort Studies of Eicosapentaenoic and Docosahexaenoic Long-Chain Omega-3 Fatty Acids and Coronary Heart Disease Risk

详细信息    查看全文

• 作者：Dominik D. Alexander ; PhD ; MSPH^a ; ^{dalexander@epidstat.com} ; Paige E. Miller ; PhD ; MPH ; RD^b ; Mary E. Van Elswyk ; PhD ; RD^c ; Connye N. Kuratko ; PhD ; RD^d ; Lauren C. Bylsma ; MPH^a
• 关键词：CHD ; coronary heart disease ; DHA ; docosahexaenoic acid ; EPA ; eicosapentaenoic acid ; HR ; hazard ratio ; LDL ; low-density lipoprotein ; MI ; myocardial infarction ; n-3 LCPUFA ; omega-3 long-chain polyunsaturated fatty acids ; RCT ; randomized controlled trial ; RR ; relative risk as represented by rate ratios and hazard ratios ; SRRE ; summary relative risk estimate
• 刊名：Mayo Clinic Proceedings
• 出版年：2017
• 出版时间：January 2017
• 年：2017
• 卷：92
• 期：1
• 页码：15-29
• 全文大小：615 K
• 卷排序：92

文摘

To conduct meta-analyses of randomized controlled trials (RCTs) to estimate the effect of eicosapentaenoic and docosahexaenoic acid (EPA+DHA) on coronary heart disease (CHD), and to conduct meta-analyses of prospective cohort studies to estimate the association between EPA+DHA intake and CHD risk.MethodsA systematic literature search of Ovid/Medline, PubMed, Embase, and the Cochrane Library from January 1, 1947, to November 2, 2015, was conducted; 18 RCTs and 16 prospective cohort studies examining EPA+DHA from foods or supplements and CHD, including myocardial infarction, sudden cardiac death, coronary death, and angina, were identified. Random-effects meta-analysis models were used to generate summary relative risk estimates (SRREs) and 95% CIs. Heterogeneity was examined in subgroup and sensitivity analyses and by meta-regression. Dose-response was evaluated in stratified dose or intake analyses. Publication bias assessments were performed.ResultsAmong RCTs, there was a nonstatistically significant reduction in CHD risk with EPA+DHA provision (SRRE=0.94; 95% CI, 0.85-1.05). Subgroup analyses of data from RCTs indicated a statistically significant CHD risk reduction with EPA+DHA provision among higher-risk populations, including participants with elevated triglyceride levels (SRRE=0.84; 95% CI, 0.72-0.98) and elevated low-density lipoprotein cholesterol (SRRE=0.86; 95% CI, 0.76-0.98). Meta-analysis of data from prospective cohort studies resulted in a statistically significant SRRE of 0.82 (95% CI, 0.74-0.92) for higher intakes of EPA+DHA and risk of any CHD event.ConclusionResults indicate that EPA+DHA may be associated with reducing CHD risk, with a greater benefit observed among higher-risk populations in RCTs.