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Grzegorz Gajos, Omega-3 polyunsaturated fatty acids: is their future VITALized or REDUCEd?, Cardiovascular Research, Volume 115, Issue 6, 01 May 2019, Pages e58–e60, https://doi.org/10.1093/cvr/cvz081
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The interest in cardioprotective effects of omega-3 polyunsaturated fatty acids (n-3 PUFAs) was sparked almost 50 years ago by the discovery that Greenland Inuits have a low incidence of myocardial infarctions and cardiovascular (CV) mortality.1 At that time, studies suggested that beneficial effects were related to the n-3 PUFA impact on bleeding time and subsequently thrombotic disorders. The cardioprotective effects of n-3 PUFAs were supported by the first landmarks studies in patients after myocardial infarction and in heart failure.1 With the advances in CV therapy, the results of subsequent randomized controlled trials (RCTs) have challenged previous observational and interventional data.1,2 A recent systematic review of all RCTs found no effects of n-3 PUFAs on effects on mortality or CV events.1 The results of very recent large RCTs—VITAL and REDUCE-IT—do not fully resolve that controversy.3,4
VITAL placebo-controlled study involved 25 871 participants randomly assigned to marine n-3 fatty acids (at a dose of 1 g/day) in the primary prevention of CV disease and cancer (Table 1).3 After a median follow-up of 5.3 years, no beneficial effects on major cardiovascular events (MACE) or cancer were demonstrated. Interestingly, in subgroup analysis in individuals with low consumption of fish during the trial (<1.5 fish servings) there was a significant 19% reduction of MACE. Secondary analysis also showed significant 28% reduction of total myocardial infarctions. Of note, the absolute risk reduction was small (0.5%).3 However, as there was no effect of the treatment on the primary endpoint of the trial, such positive signals can only be viewed as hypothesis generating.
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