Fatty acid supplementation flops for secondary CVD prevention in elderly

In elderly patients with acute myocardial infarction (AMI), taking n-3 polyunsaturated fatty acids (PUFAs) daily for 2 years does little to reduce the risk of subsequent cardiovascular disease (CVD), as shown in the OMEMI* trial.

The analysis included 1,014 older adult patients (median age, 74 years; 29 percent female; 46.1 percent had known previous CVD) with recent (2–8 weeks) AMI. Of these, 505 were randomized to receive 1.8 g n-3 PUFA (930-mg eicosapentaenoic acid [EPA] and 660-mg docosahexaenoic acid [DHA]) and 509 placebo (corn oil) daily in addition to standard of care. Mean baseline triglycerides were 111.4 mg/dL.

After 24 months, EPA and DHA levels increased 87 percent and 16 percent in the n-3 PUFA group but decreased by −13 percent and –8 percent in the placebo group, respectively.

The incidence of the primary endpoint of a composite of nonfatal AMI, unscheduled revascularization, stroke, all-cause death, and heart failure hospitalization did not significantly differ between the n-3 PUFA and placebo groups (21.4 percent vs 20.0 percent; hazard ratio [HR], 1.08, 95 percent confidence interval [CI], 0.82–1.41; p=0.60).

Meanwhile, the secondary endpoint of new atrial fibrillation occurred with slightly higher frequency on n-3 PUFA than on placebo (7.2 percent vs 4.0 percent; HR, 1.84, 95 percent CI, 0.98–3.45; p=0.06). Major bleeding rates were similar, 10.7 percent and 11.0 percent, respectively (p=0.87).

Results for per-protocol analysis (n=893) followed a similar pattern.

*Omega-3 Fatty acids in Elderly with Myocardial Infarction