Recent Study Shows both Reduced Mortality and Repeat Heart Attack after Initial Myocardial Infarction with EPA/DHA Supplementation
Greene, S. J. et al., Amer. J. Cardiology, in press , 2015
Division of Cardiology, Duke University Medical Ctr., Durham, N. C., USA
Following the GISSI-Prevenzione trial showing a significant reduction in the risk of death, non-fatal acute myocardial infarction (AMI), and stroke when post-MI patients were given approx. 1 gram (900 mg EPA plus DHA) daily, other intervention studies and reviews have led to varying results/conclusions. The present authors point out that the latter neutral reports may not be generalizable to the ‘real-world’ practice where the adaption of guideline-recommended practices is generally lower than in clinical trials for various reasons. Thus, the authors considered a reappraisal of the omega-3 efficiency to be warranted. The goal of the present study was to determine the influence of prescription EPA/DHA supplementation on postdischarge outcomes in a large, “real-world”, contemporary cohort of patients having suffered an acute myocardial infarction (AMI).
This study involved analyses of administrative databases maintained by 5 Italian local Health Units. The majority of the patients (average age of 69 years) were males and most were receiving various cardio-protective medications (statins, anti-platelets, beta-blockers, ACE-inhibitors/angiotensin II receptor blockers); about half were receiving anti-hypertensives. Of the patients studied, 2,425 were given EPA/DHA treatment and 8,844 were not. The follow-up period was 12 months. The daily dose of omega-3 was considered to be 1 gm/day (providing 850-882 mg of EPA plus DHA in ethyl ester form with an EPA: DHA ratio of 1:2 as in the GISSI-Prevenzione study).
In this large contemporary observational study wherein approx. one-fifth of the patients were prescribed EPA/DHA after an AMI, omega-3 therapy was associated with a highly significant reduction in all-cause mortality (by 24 %) and in recurrent AMI (by 35 %) through the 12-month follow-up period. Interestingly, an occasional interaction between specific medication use and the protective effect of omega-3 use was exhibited. For example, the benefit of omega-3 in protecting against recurrent AMI was seen only in those patients who were on statin treatment and not in those who were not taking such. Overall, the authors concluded that, in this large study of “real world” Italian patients hospitalized for AMI, the use EPA/DHA omega-3 supplementation (in addition to standard treatment) ‘was independently associated with a robust reduction in all-cause mortality and recurrent AMI’.
Dr. Holub's Comments:
This present study is of considerable importance with respect to the optimal management of post-MI patients since it is uniquely targeted towards “real-world” patients as emphasized by the team of investigators. It is anticipated that this extensive study will buffer and offset some of the recent controversies regarding the complementary benefit of EPA/DHA supplementation in these patients. Interestingly, the reported benefits of EPA/DHA treatment found in the present study were apparent even though the researchers determined that approximately half of the patients receiving omega-3 demonstrated a compliance of 80 % or less.