To the Editor ω-3 Polyunsaturated fatty acid (PUFA) supplementation was not associated with a lower risk for adverse cardiovascular outcome in the study by Aung et al.1 These results are not surprising, and several issues may have affected these neutral outcomes. The GISSI-Prevenzione trial2 demonstrated that at least 1 g per day of ω-3 PUFAs is required for cardiovascular benefit in patients postinfarction. Most of the studies in the meta-analysis by Aung et al1 used a lower dose of ω-3 PUFAs that was insufficient for cardioprotection. Polyunsaturated fatty acids have no effects in normal patients or in those with low risk of ischemic events. Some of the studies cited included patients postinfarction optimally treated after primary angioplasty who had preserved left ventricular ejection fraction or patients who were enrolled years after an infarction; these patients have risk profiles that are vastly different from those of patients enrolled early after an acute event. In a large, contemporary, observational study of real-world patients hospitalized for acute myocardial infarction,3 we demonstrated that a sizable proportion of patients did not undergo primary angioplasty and had reduced ejection fraction. In this cohort, early use of ω-3 PUFAs was independently associated with a robust reduction in 1-year all-cause mortality and recurrent infarction. Some trials in the meta-analysis by Aung et al1 were too short to show any effect. Finally, the authors state that the 95% CIs cannot exclude a 7% lower risk of major cardiovascular events and a 10% lower risk of ischemic events associated with ω-3 PUFA supplementation.1 Thus, patient risk profile, duration of treatment, and supplementation dose may all affect the efficacy of this therapy and, in turn, the conclusion of the published meta-analysis.1 While we await the results of ongoing large randomized trials, it is prudent to continue with the American Heart Association4 recommendation that in the first year after an infarction in patients with left ventricular dysfunction and a high arrhythmic risk, supplementation with at least 1 g per day of ω-3 PUFA remains cost-effective and justified.
Nodari S, Butler J, Temporelli PL. Questioning the Associations of ω-3 Fatty Acid Supplement Use With Cardiovascular Disease Risks. JAMA Cardiol. Published online June 06, 2018. doi:10.1001/jamacardio.2018.1309
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