Figure 1 — Analytical Framework of Study


*high risk for CVD = DM, CMS, HTN, dyslipidemia, CKD (Click on table to see larger version)

Table 1 — Efficacy Results for Various Individual n-3 FA*


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n-3 FA

Evidence

Total n-3 FA (ALA+EPA+DHA)

• Insufficient evidence to determine effect/association of intake with clinical or intermediate outcomes
• No association between intake and stroke death, MI (low)

Total Marine Oil (EPA+DHA+/-DPA)

• Decrease Tg: -24 mg/dL (95% CI -31, -18) (high)
         o Greater effect seen with higher doses and in patients with higher baseline Tg:
                      — Metaregression: increase of EPA + DHA dose by 1g/day associated with change of Tg of -5.9mg/dL (95% CI -9.9 to -2.0)
                      — Most trials: no consistent dose effect
• Some evidence indicated larger reduction of Tg in doses ≥3g/day versus lower doses; however, doses <3g/day yielded smaller reductions in Tg versus even lower doses
                      — Baseline Tg level increase of 1mg/dL associated with change of Tg of -0.15mg/dL (95% CI -0.22 to -0.08)
• Increase HDL-c: 0.9 mg/dL (95% CI 0.2, 1.6) (high)
• Increase LDL-c: 2.0 mg/dL (95% CI 0.4, 3.6) (high)
• Decrease Total:HDL-c ratio: -0.17 (95% CI -0.26, -0.09) (high)
• No effect on risk of MACE, all-cause death, SCD, revascularization, BP (high)
• No effect on risk of AFib (moderate)
• Lower risk of ischemic stroke: 0.51 (95% CI 0.28, 0.89) per g/day (low)
         o Associated with higher dietary marine oil intake (doses of 0.025–0.6g/day)
• No effect on risk of CVD death, CHD death, total CHD, MI, angina pectoris, CHF, total stroke, hemorrhagic stroke (low)

EPA

• Insufficient evidence to determine effect/association with most CVD clinical or intermediate outcomes
• No association between intake and CHD (low)
• No association between EPA biomarkers and AFib (low)

DHA

• Insufficient evidence to determine effect/association with CVD clinical or intermediate outcomes
• No effect on BP or LDL-c (moderate)
• No association between intake and incident CHD (low)

DPA

• Insufficient evidence to determine effect/association with most CVD clinical or intermediate outcomes
• No association between DPA biomarker levels and risk of AFib (low)

SDA

• Insufficient evidence to determine effect/association with CVD clinical or intermediate outcomes

ALA

• No effect on BP, LDL-c, HDL-c, Tg (moderate)
• No association between intake or biomarker level and CHD or CHD death, AFib, CHF (low)
• Insufficient evidence regarding other outcomes

Marine Oil vs. ALA

• Insufficient evidence of direct comparison of marine oil and ALA
• Indirect comparison unclear; results found that marine oil improves Tg and HDL-c (high) and ALA has no effect on these outcomes (moderate)

n-3 FA with Different Ratios

• No study directly compared efficacy/associations with outcomes

n-3 FA Obtained from Different Sources

• No study directly compared efficacy/associations with outcomes

*Level of evidence is noted in parentheses