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Subsequently, several studies identified eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), two major long chain n-3 polyunsaturated fatty acids (n-3 PUFAs), as the putative protective constituents. Interest in the therapeutic value of fish oils began in the 1970's following the observation of a low incidence of cardiovascular disease in Greenland Inuits. Additional high quality studies are required to clarify the role of omega-3 fatty acid supplementation for the secondary prevention of cardiovascular disease. However, caution must be exercised in interpreting these benefits as results were attenuated in higher quality studies, suggesting that bias may be at least partially responsible. ConclusionsĪlthough not reaching conventional statistical significance, the evidence to date suggests that omega-3 fatty acids may result in a modest reduction in mortality and restenosis. No serious safety issues were identified.

However in meta-regressions, there was a >90% probability that larger studies and those with longer follow-up were associated with smaller benefits. Omega-3 fatty acids were not associated with a statistically significant decreased mortality (relative risk = 0.88, 95% Credible Interval = 0.64, 1.03) or with restenosis prevention (RR = 0.89, 95% CrI = 0.72, 1.06), though the probability of some benefit remains high (0.93 and 0.90, respectively). ResultsĪ total of 29 RCTs (n = 35,144) met our inclusion criteria, with 25 reporting mortality and 14 reporting restenosis. Meta-analyses were carried out using Bayesian random-effects models, and heterogeneity was examined using meta-regression. The primary outcome was all-cause mortality and secondary outcomes were coronary restenosis following percutaneous coronary intervention and safety. The Cochrane library, MEDLINE, and EMBASE were systematically searched to identify all interventional trials of omega-3 fatty acids compared to placebo or usual diet in high-risk cardiovascular patients. A meta-analysis of these RCTs to estimate efficacy and safety and potential sources of heterogeneity may be helpful. Multiple randomized controlled trials (RCTs) have examined the cardiovascular effects of omega-3 fatty acids and have provided unexplained conflicting results.