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Meta-Analysis
. 2018 Jul 18;7(7):CD003177.
doi: 10.1002/14651858.CD003177.pub3.

Omega-3 fatty acids for the primary and secondary prevention of cardiovascular disease

Asmaa S Abdelhamid  1 , Tracey J Brown, Julii S Brainard, Priti Biswas, Gabrielle C Thorpe, Helen J Moore, Katherine Ho Deane, Fai K AlAbdulghafoor, Carolyn D Summerbell, Helen V Worthington, Fujian Song, Lee Hooper
Affiliations
Meta-Analysis

Omega-3 fatty acids for the primary and secondary prevention of cardiovascular disease

Asmaa S Abdelhamid et al. Cochrane Database Syst Rev. .

Update in

Abstract

Background: Researchers have suggested that omega-3 polyunsaturated fatty acids from oily fish (long-chain omega-3 (LCn3), including eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA)), as well as from plants (alpha-linolenic acid (ALA)) benefit cardiovascular health. Guidelines recommend increasing omega-3-rich foods, and sometimes supplementation, but recent trials have not confirmed this.

Objectives: To assess effects of increased intake of fish- and plant-based omega-3 for all-cause mortality, cardiovascular (CVD) events, adiposity and lipids.

Search methods: We searched CENTRAL, MEDLINE and Embase to April 2017, plus ClinicalTrials.gov and World Health Organization International Clinical Trials Registry to September 2016, with no language restrictions. We handsearched systematic review references and bibliographies and contacted authors.

Selection criteria: We included randomised controlled trials (RCTs) that lasted at least 12 months and compared supplementation and/or advice to increase LCn3 or ALA intake versus usual or lower intake.

Data collection and analysis: Two review authors independently assessed studies for inclusion, extracted data and assessed validity. We performed separate random-effects meta-analysis for ALA and LCn3 interventions, and assessed dose-response relationships through meta-regression.

Main results: We included 79 RCTs (112,059 participants) in this review update and found that 25 were at low summary risk of bias. Trials were of 12 to 72 months' duration and included adults at varying cardiovascular risk, mainly in high-income countries. Most studies assessed LCn3 supplementation with capsules, but some used LCn3- or ALA-rich or enriched foods or dietary advice compared to placebo or usual diet.Meta-analysis and sensitivity analyses suggested little or no effect of increasing LCn3 on all-cause mortality (RR 0.98, 95% CI 0.90 to 1.03, 92,653 participants; 8189 deaths in 39 trials, high-quality evidence), cardiovascular mortality (RR 0.95, 95% CI 0.87 to 1.03, 67,772 participants; 4544 CVD deaths in 25 RCTs), cardiovascular events (RR 0.99, 95% CI 0.94 to 1.04, 90,378 participants; 14,737 people experienced events in 38 trials, high-quality evidence), coronary heart disease (CHD) mortality (RR 0.93, 95% CI 0.79 to 1.09, 73,491 participants; 1596 CHD deaths in 21 RCTs), stroke (RR 1.06, 95% CI 0.96 to 1.16, 89,358 participants; 1822 strokes in 28 trials) or arrhythmia (RR 0.97, 95% CI 0.90 to 1.05, 53,796 participants; 3788 people experienced arrhythmia in 28 RCTs). There was a suggestion that LCn3 reduced CHD events (RR 0.93, 95% CI 0.88 to 0.97, 84,301 participants; 5469 people experienced CHD events in 28 RCTs); however, this was not maintained in sensitivity analyses - LCn3 probably makes little or no difference to CHD event risk. All evidence was of moderate GRADE quality, except as noted.Increasing ALA intake probably makes little or no difference to all-cause mortality (RR 1.01, 95% CI 0.84 to 1.20, 19,327 participants; 459 deaths, 5 RCTs),cardiovascular mortality (RR 0.96, 95% CI 0.74 to 1.25, 18,619 participants; 219 cardiovascular deaths, 4 RCTs), and it may make little or no difference to CHD events (RR 1.00, 95% CI 0.80 to 1.22, 19,061 participants, 397 CHD events, 4 RCTs, low-quality evidence). However, increased ALA may slightly reduce risk of cardiovascular events (from 4.8% to 4.7%, RR 0.95, 95% CI 0.83 to 1.07, 19,327 participants; 884 CVD events, 5 RCTs, low-quality evidence), and probably reduces risk of CHD mortality (1.1% to 1.0%, RR 0.95, 95% CI 0.72 to 1.26, 18,353 participants; 193 CHD deaths, 3 RCTs), and arrhythmia (3.3% to 2.6%, RR 0.79, 95% CI 0.57 to 1.10, 4,837 participants; 141 events, 1 RCT). Effects on stroke are unclear.Sensitivity analysis retaining only trials at low summary risk of bias moved effect sizes towards the null (RR 1.0) for all LCn3 primary outcomes except arrhythmias, but for most ALA outcomes, effect sizes moved to suggest protection. LCn3 funnel plots suggested that adding in missing studies/results would move effect sizes towards null for most primary outcomes. There were no dose or duration effects in subgrouping or meta-regression.There was no evidence that increasing LCn3 or ALA altered serious adverse events, adiposity or lipids, although LCn3 slightly reduced triglycerides and increased HDL. ALA probably reduces HDL (high- or moderate-quality evidence).

Authors' conclusions: This is the most extensive systematic assessment of effects of omega-3 fats on cardiovascular health to date. Moderate- and high-quality evidence suggests that increasing EPA and DHA has little or no effect on mortality or cardiovascular health (evidence mainly from supplement trials). Previous suggestions of benefits from EPA and DHA supplements appear to spring from trials with higher risk of bias. Low-quality evidence suggests ALA may slightly reduce CVD event risk, CHD mortality and arrhythmia.

PubMed Disclaimer

Conflict of interest statement

ASA: none known. TJB: none known. JSB: none known. PB: none known. GCT: none known. HJM: none known. KHOD: none known. FKA: none known. CDS: none known. HVW: none known. FS: none known. LH: none known.

Figures

Figure 1
Figure 1
Study flow diagram.
Figure 2
Figure 2
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Figure 3
Figure 3
Funnel plot of comparison: 1 High vs low LCn3 omega‐3 fats (primary outcomes), outcome: 1.1 Aall‐cause mortality (overall) – LCn3.
Figure 4
Figure 4
Funnel plot of comparison: 1 High vs low LCn3 omega‐3 fats (primary outcomes), outcome: 1.11 Cardiovascular mortality (overall) – LCn3.
Figure 5
Figure 5
Funnel plot of comparison: 1 High vs low LCn3 omega‐3 fats (primary outcomes), outcome: 1.31 Coronary heart disease mortality (overall) – LCn3.
Figure 6
Figure 6
Funnel plot of comparison: 1 High vs low LCn3 omega‐3 fats (primary outcomes), outcome: 1.43 Coronary heart disease events (overall) – LCn3.
Analysis 1.1
Analysis 1.1
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 1 All‐cause mortality (overall) ‐ LCn3.
Analysis 1.2
Analysis 1.2
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 2 All‐cause mortality ‐ LCn3 ‐ sensitivity analysis (SA) fixed‐effect.
Analysis 1.3
Analysis 1.3
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 3 All‐cause mortality ‐ LCn3 ‐ SA by summary risk of bias.
Analysis 1.4
Analysis 1.4
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 4 All‐cause mortality ‐ LCn3 ‐ SA by compliance and study size.
Analysis 1.5
Analysis 1.5
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 5 All‐cause mortality ‐ LCn3 ‐ subgroup by dose.
Analysis 1.6
Analysis 1.6
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 6 All‐cause mortality ‐ LCn3 ‐ subgroup by replacement.
Analysis 1.7
Analysis 1.7
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 7 All‐cause mortality ‐ LCn3 ‐ subgroup by intervention type.
Analysis 1.8
Analysis 1.8
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 8 All‐cause mortality ‐ LCn3 ‐ subgroup by duration.
Analysis 1.9
Analysis 1.9
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 9 All‐cause mortality ‐ LCn3 ‐ subgroup by primary or secondary prevention.
Analysis 1.10
Analysis 1.10
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 10 All‐cause mortality ‐ LCn3 ‐ subgroup by statin use.
Analysis 1.11
Analysis 1.11
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 11 Cardiovascular mortality (overall) ‐ LCn3.
Analysis 1.12
Analysis 1.12
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 12 CVD mortality ‐ LCn3 ‐ SA fixed‐effect.
Analysis 1.13
Analysis 1.13
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 13 CVD mortality ‐ LCn3 ‐ SA by summary risk of bias.
Analysis 1.14
Analysis 1.14
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 14 CVD mortality ‐ LCn3 ‐ SA by compliance and study size.
Analysis 1.15
Analysis 1.15
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 15 CVD mortality ‐ LCn3 ‐ subgroup by dose.
Analysis 1.16
Analysis 1.16
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 16 CVD mortality ‐ LCn3 ‐ subgroup by replacement.
Analysis 1.17
Analysis 1.17
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 17 CVD mortality ‐ LCn3 ‐ subgroup by intervention type.
Analysis 1.18
Analysis 1.18
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 18 CVD mortality ‐ LCn3 ‐ subgroup by duration.
Analysis 1.19
Analysis 1.19
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 19 CVD mortality ‐ LCn3 ‐ subgroup by primary or secondary prevention.
Analysis 1.20
Analysis 1.20
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 20 CVD mortality ‐ LCn3 ‐ subgroup by statin uses.
Analysis 1.21
Analysis 1.21
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 21 Cardiovascular events (overall) ‐ LCn3.
Analysis 1.22
Analysis 1.22
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 22 CVD events ‐ LCn3 ‐ SA fixed‐effect.
Analysis 1.23
Analysis 1.23
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 23 CVD events ‐ LCn3 ‐ SA by summary risk of bias.
Analysis 1.24
Analysis 1.24
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 24 CVD events ‐ LCn3 ‐ SA by compliance and study size.
Analysis 1.25
Analysis 1.25
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 25 CVD events ‐ LCn3 ‐ subgroup by dose.
Analysis 1.26
Analysis 1.26
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 26 CVD events ‐ LCn3 ‐ subgroup by replacement.
Analysis 1.27
Analysis 1.27
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 27 CVD events ‐ LCn3 ‐ subgroup by intervention type.
Analysis 1.28
Analysis 1.28
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 28 CVD events ‐ LCn3 ‐ subgroup by duration.
Analysis 1.29
Analysis 1.29
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 29 CVD events ‐ LCn3 ‐ subgroup by primary or secondary prevention.
Analysis 1.30
Analysis 1.30
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 30 CVD events ‐ LCn3 ‐ subgroup by statin use.
Analysis 1.31
Analysis 1.31
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 31 Coronary heart disease mortality (overall) ‐ LCn3.
Analysis 1.32
Analysis 1.32
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 32 CHD mortality ‐ LCn3 ‐ SA fixed‐effect.
Analysis 1.33
Analysis 1.33
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 33 CHD mortality ‐ LCn3 ‐ SA by summary risk of bias.
Analysis 1.34
Analysis 1.34
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 34 CHD mortality ‐ LCn3 ‐ SA by compliance and study size.
Analysis 1.35
Analysis 1.35
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 35 CHD mortality ‐ LCn3 ‐ SA omitting cardiac death.
Analysis 1.36
Analysis 1.36
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 36 CHD mortality ‐ LCn3 ‐ subgroup by dose.
Analysis 1.37
Analysis 1.37
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 37 CHD mortality ‐ LCn3 ‐ subgroup by replacement.
Analysis 1.38
Analysis 1.38
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 38 CHD mortality ‐ LCn3 ‐ subgroup by intervention type.
Analysis 1.39
Analysis 1.39
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 39 CHD mortality ‐ LCn3 ‐ subgroup by duration.
Analysis 1.40
Analysis 1.40
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 40 CHD mortality ‐ LCn3 ‐ subgroup by primary or secondary prevention.
Analysis 1.41
Analysis 1.41
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 41 CHD mortality ‐ LCn3 ‐ subgroup by statin use.
Analysis 1.42
Analysis 1.42
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 42 CHD mortality ‐ LCn3 ‐ subgroup by CAD history.
Analysis 1.43
Analysis 1.43
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 43 Coronary heart disease events (overall) ‐ LCn3.
Analysis 1.44
Analysis 1.44
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 44 CHD events ‐ LCn3 ‐ SA fixed‐effect.
Analysis 1.45
Analysis 1.45
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 45 CHD events ‐ LCn3 ‐ SA by summary risk of bias.
Analysis 1.46
Analysis 1.46
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 46 CHD events ‐ LCn3 ‐ SA by compliance and study size.
Analysis 1.47
Analysis 1.47
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 47 CHD events ‐ LCn3 ‐ subgroup by dose.
Analysis 1.48
Analysis 1.48
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 48 CHD events ‐ LCn3 ‐ subgroup by replacement.
Analysis 1.49
Analysis 1.49
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 49 CHD events ‐ LCn3 ‐ subgroup by intervention type.
Analysis 1.50
Analysis 1.50
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 50 CHD events ‐ LCn3 ‐ subgroup by duration.
Analysis 1.51
Analysis 1.51
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 51 CHD events ‐ LCn3 ‐ subgroup by primary or secondary prevention.
Analysis 1.52
Analysis 1.52
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 52 CHD events ‐ LCn3 ‐ subgroup by statin use.
Analysis 1.53
Analysis 1.53
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 53 CHD events ‐ LCn3 subgroup by CAD history.
Analysis 1.54
Analysis 1.54
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 54 Stroke (overall) ‐ LCn3.
Analysis 1.55
Analysis 1.55
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 55 Stroke ‐ LCn3 ‐ SA fixed‐effect.
Analysis 1.56
Analysis 1.56
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 56 Stroke ‐ LCn3 ‐ SA by summary risk of bias.
Analysis 1.57
Analysis 1.57
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 57 Stroke ‐ LCn3 ‐ SA by compliance and study size.
Analysis 1.58
Analysis 1.58
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 58 Stroke ‐ LCn3 ‐ subgroup by stroke type.
Analysis 1.59
Analysis 1.59
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 59 Stroke ‐ LCn3 ‐ subgroup by dose.
Analysis 1.60
Analysis 1.60
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 60 Stroke ‐ LCn3 ‐ subgroup by replacement.
Analysis 1.61
Analysis 1.61
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 61 Stroke ‐ LCn3 ‐ subgroup by intervention type.
Analysis 1.62
Analysis 1.62
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 62 Stroke ‐ LCn3 ‐ subgroup by duration.
Analysis 1.63
Analysis 1.63
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 63 Stroke ‐ LCn3 ‐ subgroup by primary or secondary prevention.
Analysis 1.64
Analysis 1.64
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 64 Stroke ‐ LCn3 ‐ subgroup by statin use.
Analysis 1.65
Analysis 1.65
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 65 Arrythmia (overall) ‐ LCn3.
Analysis 1.66
Analysis 1.66
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 66 Arrhythmia‐ LCn3 ‐ SA fixed‐effect.
Analysis 1.67
Analysis 1.67
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 67 Arrhythmia‐ LCn3 ‐ SA by summary risk of bias.
Analysis 1.68
Analysis 1.68
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 68 Arrhythmia‐ LCn3 ‐ SA by compliance and study size.
Analysis 1.69
Analysis 1.69
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 69 Arrhythmia ‐ LCn3 ‐ subgroup by new or recurrent.
Analysis 1.70
Analysis 1.70
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 70 Arrhythmia ‐ LCn3 ‐ subgroup by fatality.
Analysis 1.71
Analysis 1.71
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 71 Arrhythmia ‐ LCn3 ‐ subgroup by dose.
Analysis 1.72
Analysis 1.72
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 72 Arrhythmia ‐ LCn3 ‐ subgroup by replacement.
Analysis 1.73
Analysis 1.73
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 73 Arrhythmia ‐ LCn3 ‐ subgroup by intervention type.
Analysis 1.74
Analysis 1.74
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 74 Arrhythmia ‐ LCn3 ‐ subgroup by duration.
Analysis 1.75
Analysis 1.75
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 75 Arrhythmia ‐ LCn3 ‐ subgroup by primary or secondary prevention3.
Analysis 1.76
Analysis 1.76
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 76 Arrhythmia ‐ LCn3 ‐ subgroup by statin use.
Analysis 2.1
Analysis 2.1
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 1 MACCEs ‐ LCn3.
Analysis 2.2
Analysis 2.2
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 2 Myocardial infarction (overall) ‐ LCn3.
Analysis 2.3
Analysis 2.3
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 3 Total MI ‐ sensitivity analysis (SA) by summary risk of bias.
Analysis 2.4
Analysis 2.4
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 4 Total MI ‐ LCn3 ‐ SA by compliance and study size.
Analysis 2.5
Analysis 2.5
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 5 Total MI ‐ LCn3 ‐ subgroup by fatality.
Analysis 2.6
Analysis 2.6
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 6 Sudden cardiac death (overall) ‐ LCn3.
Analysis 2.7
Analysis 2.7
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 7 Angina ‐ LCn3.
Analysis 2.8
Analysis 2.8
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 8 Heart failure ‐ LCn3.
Analysis 2.9
Analysis 2.9
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 9 Revascularisation ‐ LCn3.
Analysis 2.10
Analysis 2.10
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 10 Peripheral arterial disease ‐ LCn3.
Analysis 2.11
Analysis 2.11
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 11 PAD ‐ LCn3 ‐ SA by summary risk of bias.
Analysis 2.12
Analysis 2.12
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 12 PAD ‐ LCn3 ‐ SA compliance and study size.
Analysis 2.13
Analysis 2.13
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 13 Acute coronary syndrome ‐ LCn3.
Analysis 2.14
Analysis 2.14
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 14 Body weight, kg ‐ LCn3.
Analysis 2.15
Analysis 2.15
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 15 Weight, kg ‐ LCn3 ‐ SA by summary risk of bias.
Analysis 2.16
Analysis 2.16
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 16 Weight, kg ‐ LCn3 ‐ SA by compliance and study size.
Analysis 2.17
Analysis 2.17
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 17 Weight, kg ‐ LCn3 ‐ subgroup by dose.
Analysis 2.18
Analysis 2.18
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 18 Weight, kg ‐ LCn3 ‐ subgroup by replacement.
Analysis 2.19
Analysis 2.19
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 19 Weight, kg ‐ LCn3 ‐ subgroup by intervention type.
Analysis 2.20
Analysis 2.20
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 20 Weight, kg ‐ LCn3 ‐ subgroup by duration.
Analysis 2.21
Analysis 2.21
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 21 Weight, kg ‐ LCn3 ‐ subgroup by primary or secondary prevention.
Analysis 2.22
Analysis 2.22
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 22 Weight, kg ‐ LCn3 ‐ subgroup by statin use.
Analysis 2.23
Analysis 2.23
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 23 Body mass index, kg/m² ‐ LCn3.
Analysis 2.24
Analysis 2.24
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 24 BMI, kg/m²‐ LCn3 ‐ SA by summary risk of bias.
Analysis 2.25
Analysis 2.25
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 25 BMI, kg/m²‐ LCn3 ‐ SA by compliance and study size.
Analysis 2.26
Analysis 2.26
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 26 BMI, kg/m² ‐ LCn3 ‐ subgroup by dose.
Analysis 2.27
Analysis 2.27
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 27 BMI, kg/m² ‐ LCn3 ‐ subgroup by replacement.
Analysis 2.28
Analysis 2.28
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 28 BMI, kg/m² ‐ LCn3 ‐ subgroup by intervention type.
Analysis 2.29
Analysis 2.29
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 29 BMI, kg/m² ‐ LCn3 ‐ subgroup by duration.
Analysis 2.30
Analysis 2.30
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 30 BMI, kg/m² ‐ LCn3 ‐ subgroup by primary or secondary prevention.
Analysis 2.31
Analysis 2.31
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 31 BMI, kg/m² ‐ LCn3 ‐ subgroup by statin use.
Analysis 2.32
Analysis 2.32
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 32 Other measures of adiposity ‐ LCn3.
Analysis 2.33
Analysis 2.33
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 33 Total cholesterol, serum, mmoL/L ‐ LCn3.
Analysis 2.34
Analysis 2.34
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 34 TC, mmoL/L ‐ LCn3 ‐ SA by summary risk of bias.
Analysis 2.35
Analysis 2.35
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 35 TC, mmoL/L ‐ LCn3 ‐ SA by compliance and study size.
Analysis 2.36
Analysis 2.36
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 36 TC, mmoL/L ‐ LCn3 ‐ subgroup by dose.
Analysis 2.37
Analysis 2.37
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 37 TC, mmoL/L ‐ LCn3 ‐ subgroup by replacement.
Analysis 2.38
Analysis 2.38
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 38 TC, mmoL/L ‐ LCn3 ‐ subgroup by intervention type.
Analysis 2.39
Analysis 2.39
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 39 TC, mmoL/L ‐ LCn3 ‐ subgroup by duration.
Analysis 2.40
Analysis 2.40
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 40 TC, mmoL/L ‐ LCn3 ‐ subgroup by primary or secondary prevention.
Analysis 2.41
Analysis 2.41
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 41 TC, mmoL/L ‐ LCn3 ‐ subgroup by statin use.
Analysis 2.42
Analysis 2.42
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 42 Triglycerides, fasting, serum, mmoL/L ‐ LCn3.
Analysis 2.43
Analysis 2.43
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 43 TG, fasting, mmoL/L ‐ LCn3 ‐ SA by summary risk of bias.
Analysis 2.44
Analysis 2.44
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 44 TG, fasting, mmoL/L ‐ LCn3 ‐ SA by compliance and study size.
Analysis 2.45
Analysis 2.45
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 45 TG, fasting, mmoL/L ‐ LCn3 ‐ subgroup by dose.
Analysis 2.46
Analysis 2.46
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 46 TG, fasting, mmoL/L ‐ LCn3 ‐ subgroup by replacement.
Analysis 2.47
Analysis 2.47
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 47 TG, fasting, mmoL/L ‐ LCn3 ‐ subgroup by intervention type.
Analysis 2.48
Analysis 2.48
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 48 TG, fasting, mmoL/L ‐ LCn3 ‐ subgroup by duration.
Analysis 2.49
Analysis 2.49
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 49 TG, fasting, mmoL/L ‐ LCn3 ‐ subgroup by primary or secondary prevention.
Analysis 2.50
Analysis 2.50
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 50 TG, fasting, mmoL/L ‐ LCn3 ‐ subgroup by statin use.
Analysis 2.51
Analysis 2.51
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 51 High‐density lipoprotein, serum, mmoL/L ‐ LCn3.
Analysis 2.52
Analysis 2.52
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 52 HDL, mmoL/L ‐ LCn3 ‐ SA by summary risk of bias.
Analysis 2.53
Analysis 2.53
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 53 HDL, mmoL/L ‐ LCn3 ‐ SA by compliance and study size.
Analysis 2.54
Analysis 2.54
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 54 HDL, mmoL/L ‐ LCn3 ‐ subgroup by dose.
Analysis 2.55
Analysis 2.55
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 55 HDL, mmoL/L ‐ LCn3 ‐ subgroup by replacement.
Analysis 2.56
Analysis 2.56
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 56 HDL, mmoL/L ‐ LCn3 ‐ subgroup by intervention type.
Analysis 2.57
Analysis 2.57
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 57 HDL, mmoL/L ‐ LCn3 ‐ subgroup by duration.
Analysis 2.58
Analysis 2.58
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 58 HDL, mmoL/L ‐ LCn3 ‐ subgroup by primary or secondary prevention.
Analysis 2.59
Analysis 2.59
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 59 HDL, mmoL/L ‐ LCn3 ‐ subgroup by statin use.
Analysis 2.60
Analysis 2.60
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 60 Low‐density lipoprotein, serum, mmoL/L ‐ LCn3.
Analysis 2.61
Analysis 2.61
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 61 LDL, mmoL/L ‐ LCn3 ‐ SA by summary risk of bias.
Analysis 2.62
Analysis 2.62
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 62 LDL, mmoL/L ‐ LCn3 ‐ SA by compliance and study size.
Analysis 2.63
Analysis 2.63
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 63 LDL, mmoL/L ‐ LCn3 ‐ subgroup by dose.
Analysis 2.64
Analysis 2.64
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 64 LDL, mmoL/L ‐ LCn3 ‐ subgroup by replacement.
Analysis 2.65
Analysis 2.65
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 65 LDL, mmoL/L ‐ LCn3 ‐ subgroup by intervention type.
Analysis 2.66
Analysis 2.66
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 66 LDL, mmoL/L ‐ LCn3 ‐ subgroup by duration.
Analysis 2.67
Analysis 2.67
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 67 LDL, mmoL/L ‐ LCn3 ‐ subgroup by primary or secondary prevention.
Analysis 2.68
Analysis 2.68
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 68 LDL, mmoL/L ‐ LCn3 ‐ subgroup by statin use.
Analysis 3.1
Analysis 3.1
Comparison 3 High vs low LCn3 omega‐3 fats (tertiary outcomes), Outcome 1 Blood pressure, mmHg ‐ LCn3.
Analysis 3.2
Analysis 3.2
Comparison 3 High vs low LCn3 omega‐3 fats (tertiary outcomes), Outcome 2 Serious adverse events ‐ LCn3.
Analysis 3.3
Analysis 3.3
Comparison 3 High vs low LCn3 omega‐3 fats (tertiary outcomes), Outcome 3 Side effects ‐ LCn3.
Analysis 3.4
Analysis 3.4
Comparison 3 High vs low LCn3 omega‐3 fats (tertiary outcomes), Outcome 4 Dropouts ‐ LCn3.
Analysis 4.1
Analysis 4.1
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 1 All‐cause mortality (overall) ‐ ALA.
Analysis 4.2
Analysis 4.2
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 2 All‐cause mortality ‐ ALA ‐ sensitivity analysis (SA) fixed‐effect.
Analysis 4.3
Analysis 4.3
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 3 All‐cause mortality ‐ ALA ‐ SA by summary risk of bias.
Analysis 4.4
Analysis 4.4
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 4 All‐cause mortality ‐ ALA ‐ SA by compliance and study size.
Analysis 4.5
Analysis 4.5
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 5 All‐cause mortality ‐ ALA ‐ subgroup by dose.
Analysis 4.6
Analysis 4.6
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 6 All‐cause mortality ‐ ALA ‐ subgroup by replacement.
Analysis 4.7
Analysis 4.7
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 7 All cause mortality ‐ ALA ‐ subgroup by intervention type.
Analysis 4.8
Analysis 4.8
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 8 All‐cause mortality ‐ ALA ‐ subgroup by duration.
Analysis 4.9
Analysis 4.9
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 9 All‐cause mortality ‐ ALA ‐ subgroup by primary or secondary prevention.
Analysis 4.10
Analysis 4.10
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 10 All‐cause mortality ‐ ALA ‐ subgroup by statin use.
Analysis 4.11
Analysis 4.11
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 11 Cardiovascular mortality (overall) ‐ ALA.
Analysis 4.12
Analysis 4.12
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 12 CVD mortality ‐ ALA ‐ SA fixed‐effect.
Analysis 4.13
Analysis 4.13
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 13 CVD mortality ‐ ALA ‐ SA by summary risk of bias.
Analysis 4.14
Analysis 4.14
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 14 CVD mortality ‐ ALA ‐ SA by compliance and study size.
Analysis 4.15
Analysis 4.15
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 15 CVD mortality ‐ ALA ‐ subgroup by dose.
Analysis 4.16
Analysis 4.16
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 16 CVD mortality ‐ ALA ‐ subgroup by replacement.
Analysis 4.17
Analysis 4.17
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 17 CVD mortality ‐ ALA ‐ subgroup by intervention type.
Analysis 4.18
Analysis 4.18
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 18 CVD mortality ‐ ALA ‐ subgroup by duration.
Analysis 4.19
Analysis 4.19
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 19 CVD mortality ‐ ALA ‐ subgroup by primary or secondary prevention.
Analysis 4.20
Analysis 4.20
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 20 CVD mortality ‐ ALA ‐ subgroup by statin uses.
Analysis 4.21
Analysis 4.21
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 21 Cardiovascular events (overall) ‐ ALA.
Analysis 4.22
Analysis 4.22
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 22 CVD events ‐ ALA ‐ SA fixed‐effect.
Analysis 4.23
Analysis 4.23
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 23 CVD events ‐ ALA ‐ SA by summary risk of bias.
Analysis 4.24
Analysis 4.24
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 24 CVD events ‐ ALA ‐ SA by compliance and study size.
Analysis 4.25
Analysis 4.25
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 25 CVD events ‐ ALA ‐ subgroup by dose.
Analysis 4.26
Analysis 4.26
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 26 CVD events ‐ ALA ‐ subgroup by replacement.
Analysis 4.27
Analysis 4.27
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 27 CVD events ‐ ALA ‐ subgroup by intervention type.
Analysis 4.28
Analysis 4.28
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 28 CVD events ‐ ALA ‐ subgroup by duration.
Analysis 4.29
Analysis 4.29
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 29 CVD events ‐ ALA ‐ subgroup by primary or secondary prevention.
Analysis 4.30
Analysis 4.30
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 30 CVD events ‐ ALA ‐ subgroup by statin use.
Analysis 4.31
Analysis 4.31
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 31 Coronary heart disease mortality (overall) ‐ ALA.
Analysis 4.32
Analysis 4.32
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 32 CHD mortality ‐ ALA ‐ SA fixed‐effect.
Analysis 4.33
Analysis 4.33
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 33 CHD mortality ‐ ALA ‐ SA by summary risk of bias.
Analysis 4.34
Analysis 4.34
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 34 CHD mortality ‐ ALA ‐ SA by compliance and study size.
Analysis 4.35
Analysis 4.35
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 35 CHD mortality ‐ ALA ‐ subgroup by dose.
Analysis 4.36
Analysis 4.36
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 36 CHD mortality ‐ ALA ‐ subgroup by replacement.
Analysis 4.37
Analysis 4.37
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 37 CHD mortality ‐ ALA ‐ subgroup by intervention type.
Analysis 4.38
Analysis 4.38
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 38 CHD mortality ‐ ALA ‐ subgroup by duration.
Analysis 4.39
Analysis 4.39
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 39 CHD mortality ‐ ALA ‐ subgroup by primary or secondary prevention.
Analysis 4.40
Analysis 4.40
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 40 CHD mortality ‐ ALA ‐ subgroup by statin use.
Analysis 4.41
Analysis 4.41
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 41 CHD mortality ‐ ALA ‐ subgroup by CAD history.
Analysis 4.42
Analysis 4.42
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 42 Coronary heart disease events (overall) ‐ ALA.
Analysis 4.43
Analysis 4.43
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 43 CHD events ‐ ALA ‐ SA fixed‐effect.
Analysis 4.44
Analysis 4.44
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 44 CHD events ‐ ALA ‐ SA by summary risk of bias.
Analysis 4.45
Analysis 4.45
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 45 CHD events ‐ ALA ‐ SA by compliance and study size.
Analysis 4.46
Analysis 4.46
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 46 CHD events ‐ ALA ‐ subgroup by dose.
Analysis 4.47
Analysis 4.47
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 47 CHD events ‐ ALA ‐ subgroup by replacement.
Analysis 4.48
Analysis 4.48
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 48 CHD events ‐ ALA ‐ subgroup by intervention type.
Analysis 4.49
Analysis 4.49
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 49 CHD events ‐ ALA ‐ subgroup by duration.
Analysis 4.50
Analysis 4.50
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 50 CHD events ‐ ALA ‐ subgroup by primary or secondary prevention.
Analysis 4.51
Analysis 4.51
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 51 CHD events ‐ ALA ‐ subgroup by statin use.
Analysis 4.52
Analysis 4.52
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 52 CHD events ‐ ALA ‐ subgroup by CAD history.
Analysis 4.53
Analysis 4.53
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 53 Stroke (overall) ‐ ALA.
Analysis 4.54
Analysis 4.54
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 54 Stroke ‐ ALA ‐ SA fixed‐effect.
Analysis 4.55
Analysis 4.55
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 55 Stroke ‐ ALA ‐ SA by summary risk of bias.
Analysis 4.56
Analysis 4.56
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 56 Stroke ‐ ALA ‐ SA by compliance and study size.
Analysis 4.57
Analysis 4.57
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 57 Stroke ‐ ALA ‐ subgroup by dose.
Analysis 4.58
Analysis 4.58
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 58 Stroke ‐ ALA ‐ subgroup by replacement.
Analysis 4.59
Analysis 4.59
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 59 Stroke ‐ ALA ‐ subgroup by intervention type.
Analysis 4.60
Analysis 4.60
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 60 Stroke ‐ ALA ‐ subgroup by duration.
Analysis 4.61
Analysis 4.61
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 61 Stroke ‐ ALA ‐ subgroup by primary or secondary prevention.
Analysis 4.62
Analysis 4.62
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 62 Stroke ‐ ALA ‐ subgroup by statin use.
Analysis 4.63
Analysis 4.63
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 63 Stroke ‐ ALA ‐ subgroup by stroke type.
Analysis 4.64
Analysis 4.64
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 64 Arrythmia (overall) ‐ ALA.
Analysis 4.65
Analysis 4.65
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 65 Arrhythmia ‐ ALA ‐ SA by summary risk of bias.
Analysis 5.1
Analysis 5.1
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 1 MACCEs ‐ ALA.
Analysis 5.2
Analysis 5.2
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 2 Myocardial infarction (overall) ‐ ALA.
Analysis 5.3
Analysis 5.3
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 3 Total MI ‐ ALA ‐ subgroup by fatality.
Analysis 5.4
Analysis 5.4
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 4 Angina ‐ ALA.
Analysis 5.5
Analysis 5.5
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 5 Revascularisation ‐ ALA.
Analysis 5.6
Analysis 5.6
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 6 Peripheral arterial disease ‐ ALA.
Analysis 5.7
Analysis 5.7
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 7 Body weight, kg ‐ ALA.
Analysis 5.8
Analysis 5.8
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 8 Weight, kg ‐ ALA ‐ sensitivity analysis (SA) fixed‐effect.
Analysis 5.9
Analysis 5.9
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 9 Weight, kg ‐ ALA ‐ SA by summary risk of bias.
Analysis 5.10
Analysis 5.10
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 10 Weight, kg ‐ ALA ‐ SA by compliance and study size.
Analysis 5.11
Analysis 5.11
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 11 Weight, kg ‐ ALA ‐ subgroup by dose.
Analysis 5.12
Analysis 5.12
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 12 Weight, kg ‐ ALA ‐ subgroup by intervention type.
Analysis 5.13
Analysis 5.13
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 13 Weight, kg ‐ ALA ‐ subgroup by replacement.
Analysis 5.14
Analysis 5.14
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 14 Weight, kg ‐ ALA ‐ subgroup by duration.
Analysis 5.15
Analysis 5.15
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 15 Weight, kg ‐ ALA ‐ subgroup by statin use.
Analysis 5.16
Analysis 5.16
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 16 Weight, kg ‐ ALA ‐ subgroup by primary or secondary prevention.
Analysis 5.17
Analysis 5.17
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 17 Body mass index, kg/m² ‐ ALA.
Analysis 5.18
Analysis 5.18
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 18 BMI, kg/m² ‐ ALA ‐ SA fixed‐effect.
Analysis 5.19
Analysis 5.19
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 19 BMI, kg/m² ‐ ALA ‐ SA by summary risk of bias.
Analysis 5.20
Analysis 5.20
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 20 BMI, kg/m² ‐ ALA ‐ SA by compliance and study size.
Analysis 5.21
Analysis 5.21
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 21 BMI, kg/m² ‐ ALA ‐ subgroup by dose.
Analysis 5.22
Analysis 5.22
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 22 BMI, kg/m² ‐ ALA ‐ subgroup by intervention type.
Analysis 5.23
Analysis 5.23
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 23 BMI, kg/m² ‐ ALA ‐ subgroup by replacement.
Analysis 5.24
Analysis 5.24
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 24 BMI, kg/m² ‐ ALA ‐ subgroup by duration.
Analysis 5.25
Analysis 5.25
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 25 BMI, kg/m² ‐ ALA ‐ subgroup by statin use.
Analysis 5.26
Analysis 5.26
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 26 BMI, kg/m² ‐ ALA ‐ subgroup by primary or secondary preventionA.
Analysis 5.27
Analysis 5.27
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 27 Other measures of adiposity ‐ ALA.
Analysis 5.28
Analysis 5.28
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 28 Total cholesterol, serum, mmoL/L ‐ ALA.
Analysis 5.29
Analysis 5.29
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 29 TC, mmoL/L ‐ ALA ‐ SA fixed‐effect.
Analysis 5.30
Analysis 5.30
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 30 TC, mmoL/L ‐ ALA ‐ SA by summary risk of bias.
Analysis 5.31
Analysis 5.31
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 31 TC, mmoL/L ‐ ALA ‐ SA by compliance and study size.
Analysis 5.32
Analysis 5.32
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 32 TC, mmoL/L ‐ ALA ‐ subgroup by dose.
Analysis 5.33
Analysis 5.33
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 33 TC, mmoL/L ‐ ALA ‐ subgroup by intervention type.
Analysis 5.34
Analysis 5.34
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 34 TC, mmoL/L ‐ ALA ‐ subgroup by replacement.
Analysis 5.35
Analysis 5.35
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 35 TC, mmoL/L ‐ ALA ‐ subgroup by duration.
Analysis 5.36
Analysis 5.36
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 36 TC, mmoL/L ‐ ALA ‐ subgroup by statin use.
Analysis 5.37
Analysis 5.37
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 37 TC, mmoL/L ‐ ALA ‐ subgroup by primary or secondary preventionA.
Analysis 5.38
Analysis 5.38
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 38 Triglycerides, fasting, serum, mmoL/L ‐ ALA.
Analysis 5.39
Analysis 5.39
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 39 TG, fasting, mmoL/L ‐ ALA ‐ SA fixed‐effect.
Analysis 5.40
Analysis 5.40
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 40 TG, fasting, mmoL/L‐ ALA ‐ SA by summary risk of bias.
Analysis 5.41
Analysis 5.41
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 41 TG, fasting, mmoL/L‐ ALA ‐ SA by compliance and study size.
Analysis 5.42
Analysis 5.42
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 42 TG, fasting, mmoL/L ‐ ALA ‐ subgroup by dose.
Analysis 5.43
Analysis 5.43
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 43 TG, fasting, mmoL/L‐ ALA ‐ subgroup by intervention type.
Analysis 5.44
Analysis 5.44
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 44 TG, fasting, mmoL/L‐AL ‐ subgroup by replacementA.
Analysis 5.45
Analysis 5.45
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 45 TG, fasting, mmoL/L‐ ALA ‐ subgroup by duration.
Analysis 5.46
Analysis 5.46
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 46 TG, fasting, mmoL/L ‐ ALA ‐ subgroup by statin use.
Analysis 5.47
Analysis 5.47
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 47 TG, fasting, mmoL/L‐ ALA ‐ subgroup by primary or secondary prevention.
Analysis 5.48
Analysis 5.48
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 48 High‐density lipoprotein, serum, mmoL/L ‐ ALA.
Analysis 5.49
Analysis 5.49
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 49 HDL, mmoL/L ‐ ALA ‐ SA fixed‐effect.
Analysis 5.50
Analysis 5.50
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 50 HDL, mmoL/L ‐ ALA ‐ SA by summary risk of bias.
Analysis 5.51
Analysis 5.51
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 51 HDL, mmoL/L ‐ ALA ‐ SA by compliance and study size.
Analysis 5.52
Analysis 5.52
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 52 HDL, mmoL/L ‐ ALA ‐ subgroup by dose.
Analysis 5.53
Analysis 5.53
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 53 HDL, mmoL/L ‐ ALA ‐ subgroup by intervention type.
Analysis 5.54
Analysis 5.54
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 54 HDL, mmoL/L ‐ ALA ‐ subgroup by replacement.
Analysis 5.55
Analysis 5.55
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 55 HDL, mmoL/L ‐ ALA ‐ subgroup by duration.
Analysis 5.56
Analysis 5.56
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 56 HDL, mmoL/L ‐ ALA ‐ subgroup by statin use.
Analysis 5.57
Analysis 5.57
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 57 HDL, mmoL/L ‐ ALA ‐ subgroup by primary or secondary prevention.
Analysis 5.58
Analysis 5.58
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 58 Low‐density lipoprotein, serum, mmoL/L ‐ ALA.
Analysis 5.59
Analysis 5.59
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 59 LDL, mmoL/L ‐ ALA ‐ SA fixed‐effect.
Analysis 5.60
Analysis 5.60
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 60 LDL, mmoL/L ‐ ALA ‐ SA by summary risk of bias.
Analysis 5.61
Analysis 5.61
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 61 LDL, mmoL/L ‐ ALA ‐ SA by compliance and study size.
Analysis 5.62
Analysis 5.62
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 62 LDL, mmoL/L ‐ ALA ‐ subgroup by dose.
Analysis 5.63
Analysis 5.63
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 63 LDL, mmoL/L ‐ ALA ‐ subgroup by intervention type.
Analysis 5.64
Analysis 5.64
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 64 LDL, mmoL/L ‐ ALA ‐ subgroup by replacement.
Analysis 5.65
Analysis 5.65
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 65 LDL, mmoL/L ‐ ALA ‐ subgroup by duration.
Analysis 5.66
Analysis 5.66
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 66 LDL, mmoL/L ‐ ALA ‐ subgroup by statin use.
Analysis 5.67
Analysis 5.67
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 67 LDL, mmoL/L ‐ ALA ‐ subgroup by primary or secondary prevention.
Analysis 6.1
Analysis 6.1
Comparison 6 High vs low ALA omega‐3 fats (tertiary outcomes), Outcome 1 Blood pressure, mmHg ‐ ALA.
Analysis 6.2
Analysis 6.2
Comparison 6 High vs low ALA omega‐3 fats (tertiary outcomes), Outcome 2 Serious adverse events ‐ ALA.
Analysis 6.3
Analysis 6.3
Comparison 6 High vs low ALA omega‐3 fats (tertiary outcomes), Outcome 3 Side effects ‐ ALA.
Analysis 6.4
Analysis 6.4
Comparison 6 High vs low ALA omega‐3 fats (tertiary outcomes), Outcome 4 Dropouts ‐ ALA.
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Update of

References

References to studies included in this review

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    5. Geleijnse JM, Giltay EJ, Schouten EG, Goede J, Oude Griep LM, Teitsma‐Jansen AM, et al. Effect of low doses of n‐3 fatty acids on cardiovascular diseases in 4,837 post‐myocardial infarction patients: design and baseline characteristics of the Alpha Omega Trial. American Heart Journal 2010;159(4):539‐46. [DOI: 10/1016/j.ahj.2009.12.033] - PubMed
    6. Giltay EJ, Geleijnse JM, Heijboer AC, Goede J, Oude Griep LM, Blankenstein MA, et al. No effects of n‐3 fatty acid supplementation on serum total testosterone levels in older men: the Alpha Omega Trial. International Journal of Andrology 2012;35(5):680‐7. - PMC - PubMed
    7. Giltay EJ, Geleijnse JM, Kromhout D. Effects of n‐3 fatty acids on depressive symptoms and dispositional optimism after myocardial infarction. American Journal of Clinical Nutrition 2011;94(6):1442‐50. - PMC - PubMed
    8. Hoogeveen E, Gemen E, Geleijnse M, Kusters R, Kromhout D, Giltay E. Effects of N‐3 fatty acids on decline of kidney function after myocardial infarction: Alpha Omega Trial. Nephrology Dialysis Transplantation 2012;27:ii64.
    9. Hoogeveen EK, Geleijnse JM, Kromhout D, Giltay EJ. No effect of n‐3 fatty acids on high‐sensitivity C‐reactive protein after myocardial infarction: the Alpha Omega Trial. European Journal of Preventive Cardiology 2014;21(11):1429‐36. - PubMed
    10. Hoogeveen EK, Geleijnse JM, Kromhout D, Stijnen T, Gemen EF, Kusters R, et al. Effect of omega‐3 fatty acids on kidney function after myocardial infarction: the Alpha Omega Trial. Clinical Journal of The American Society of Nephrology: CJASN 2014;9(10):1676‐83. - PMC - PubMed
    11. Kromhout D, Geleijnse JM, Goede J, Oude Griep LM, Mulder BJ, Boer MJ, et al. N‐3 fatty acids, ventricular arrhythmia‐related events, and fatal myocardial infarction in post myocardial infarction patients with diabetes. Diabetes Care 2011;34(12):2515‐20. - PMC - PubMed
    12. Kromhout D, Giltay EJ, Geleijnse JM, Alpha Omega Trial Group. N‐3 fatty acids and cardiovascular events after myocardial infarction. New England Journal of Medicine 2010;363(18):2015‐26. - PubMed
    1. Brouwer IA, Geleijnse JM, Klaasen VM, Smit LA, Giltay EJ, Goede J, et al. Effect of alpha linolenic acid supplementation on serum prostate specific antigen (PSA): results from the alpha omega trial. PLOS ONE 2013;8(12):e81519. - PMC - PubMed
    2. Eussen SR, Geleijnse JM, Giltay EJ, Rompelberg CJ, Klungel OH, Kromhout D. Effects of n‐3 fatty acids on major cardiovascular events in statin users and non‐users with a history of myocardial infarction. European Heart Journal 2012;33(13):1582‐8. - PMC - PubMed
    3. Geleijnse J, Giltay E, Kromhout D. Effects of n‐3 fatty acids on cognitive decline: A randomized double‐blind, placebo‐controlled trial in stable myocardial infarction patients. Alzheimer's & Dementia 2011;1:S512. - PubMed
    4. Geleijnse JM, Giltay EJ, Kromhout D. Effects of n‐3 fatty acids on cognitive decline: a randomized, double‐blind, placebo‐controlled trial in stable myocardial infarction patients. Alzheimer's & Dementia 2012;8(4):278‐87. - PubMed
    5. Geleijnse JM, Giltay EJ, Schouten EG, Goede J, Oude Griep LM, Teitsma‐Jansen AM, et al. Effect of low doses of n‐3 fatty acids on cardiovascular diseases in 4,837 post‐myocardial infarction patients: design and baseline characteristics of the Alpha Omega Trial. American Heart Journal 2010;159(4):539‐46. [DOI: 10/1016/j.ahj.2009.12.033] - PubMed
    6. Giltay EJ, Geleijnse JM, Heijboer AC, Goede J, Oude Griep LM, Blankenstein MA, et al. No effects of n‐3 fatty acid supplementation on serum total testosterone levels in older men: the Alpha Omega Trial. International Journal of Andrology 2012;35(5):680‐7. - PMC - PubMed
    7. Giltay EJ, Geleijnse JM, Kromhout D. Effects of n‐3 fatty acids on depressive symptoms and dispositional optimism after myocardial infarction. American Journal of Clinical Nutrition 2011;94(6):1442‐50. - PMC - PubMed
    8. Hoogeveen E, Gemen E, Geleijnse M, Kusters R, Kromhout D, Giltay E. Effects of N‐3 fatty acids on decline of kidney function after myocardial infarction: Alpha Omega Trial. Nephrology Dialysis Transplantation 2012;27:ii64.
    9. Hoogeveen EK, Geleijnse JM, Kromhout D, Giltay EJ. No effect of n‐3 fatty acids on high‐sensitivity C‐reactive protein after myocardial infarction: the Alpha Omega Trial. European Journal of Preventive Cardiology 2014;21(11):1429‐36. - PubMed
    10. Hoogeveen EK, Geleijnse JM, Kromhout D, Stijnen T, Gemen EF, Kusters R, et al. Effect of omega‐3 fatty acids on kidney function after myocardial infarction: the Alpha Omega Trial. Clinical Journal of The American Society of Nephrology: CJASN 2014;9(10):1676‐83. - PMC - PubMed
    11. Kromhout D, Geleijnse JM, Goede J, Oude Griep LM, Mulder BJ, Boer MJ, et al. N‐3 fatty acids, ventricular arrhythmia‐related events, and fatal myocardial infarction in post myocardial infarction patients with diabetes. Diabetes Care 2011;34(12):2515‐20. - PMC - PubMed
    12. Kromhout D, Giltay EJ, Geleijnse JM, Alpha Omega Trial Group. N‐3 fatty acids and cardiovascular events after myocardial infarction. New England Journal of Medicine 2010;363(18):2015‐26. - PubMed

References to studies excluded from this review

    1. Alekseeva RI, Sharafetdinov K, Plotnikova OA, Meshcheriakova VA, Mal'tsev GI, Kulakova SN. Effects of a diet including linseed oil on clinical and metabolic parameters in patients with type 2 diabetes mellitus. Voprosy Pitaniia 2000;69(6):32‐5. - PubMed
    1. Baleztena Gurrea J, Ruiz‐Canela M, Pardo M, Castellanos MC, Gozalo MJ, Añorbe T, et al. Utility of heavy food supplement in omega‐3 fatty acids in the prevention of dementia, in relation to the basal nutritional level, in people of advanced age: randomized multicenter study. Revista Española de Geriatría y Gerontología 2015;50:1‐49. - PubMed
    2. Bes‐Rastrollo M, Baleztena J, Aguirre I, Ruiz‐Canela M. Utility of a rich food supplement Omega‐3 fatty acids in the prevention of dementia, in relation to baseline nutritional level, in people with advanced age: multicentre randomised study [Complemento alimenticio rico en ácidos grasos omega‐3 en la prevención de la demencia: estudio aleatorizado multicéntrico]. Nutrición Clínica en Medicina 2015;9(1):38.
    1. Belch JJ, Ansell D, Madhok R, O'Dowd A, Sturrock RD. Effects of altering dietary essential fatty acids on requirements for non‐steroidal anti‐inflammatory drugs in patients with rheumatoid arthritis: a double blind placebo controlled study. Annals of the Rheumatic Diseases 1988;47(2):96‐104. - PMC - PubMed
    1. Belluzzi A, Brignola C, Campieri M, Pera A, Boschi S, Miglioli M. Effect of an enteric‐coated fish‐oil preparation on relapses in Crohn's disease. New England Journal of Medicine 13‐6‐1996;334(24):1557‐60. - PubMed
    1. Berthoux FC, Guerin C, Burgard G, Berthoux P, Alamartine E. One‐year randomized controlled trial with omega‐3 fatty acid‐fish oil in clinical renal transplantation. Transplantation Proceedings 1992;24(6):2578‐82. - PubMed

References to ongoing studies

    1. ACTRN12614000732684. The Aboriginal cardiovascular omega‐3 randomised controlled trial [The effect of omega‐3 supplementation on adverse cardiovascular (CV) events among Indigenous Australians with stable coronary artery disease: A randomized controlled trial Query!]. www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=366337 (first received 10 July 2014).
    1. Holman RR, Paul S, Farmer A, Tucker L, Stratton IM, Neil HA, et al. Atorvastatin in factorial with omega‐3 EE90 risk reduction in diabetes (AFORRD): a randomised controlled trial. Diabetologia 2009;52(1):50‐9. - PubMed
    2. Neil HA, Ceglarek U, Thiery J, Paul S, Farmer A, Holman RR. Impact of atorvastatin and omega‐3 ethyl esters 90 on plasma plant sterol concentrations and cholesterol synthesis in type 2 diabetes: a randomised placebo controlled factorial trial. Atherosclerosis 2010;213(2):512‐7. - PubMed
    1. Bowman L, Aung T, Haynes R, Armitage J. ASCEND: design and baseline characteristics of a large randomised trial in diabetes. Diabetes 2012;61:A556‐7.
    2. NCT00135226. ASCEND: A Study of Cardiovascular Events iN Diabetes [A Study of Cardiovascular Events iN Diabetes ‐ A Randomized 2x2 Factorial Study of Aspirin Versus Placebo, and of Omega‐3 Fatty Acid Supplementation Versus Placebo, for Primary Prevention of Cardiovascular Events in People With Diabetes]. https://clinicaltrials.gov/ct2/show/NCT00135226 (first received 25 August 2005).
    1. ACTRN12610000594022. Fish oil as adjunct therapy for periodontitis [Clinical efficacy of fish oil as adjunct therapy for patients with chronic periodontitis]. www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=335470 (first received 23 July 2010).
    1. ACTRN12610000032055. The Beyond Ageing Project: A selective prevention trial using novel pharmacotherapies in an older age cohort at risk for depression Query! [In older adults (60+ years) at risk for depression, can sertraline and/or omega‐3 fatty acids compared with a placebo, reduce or prevent depressive symptoms, incidence of new cases of depression and/or cognitive decline]. https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=308413 (first received 22 October 2009).
    2. Cockayne NL, Duffy SL, Bonomally R, English A, Amminger PG, Mackinnon A, et al. The Beyond Ageing Project Phase 2: a double‐blind, selective prevention, randomised, placebo‐controlled trial of omega‐3 fatty acids and sertraline in an older age cohort at risk for depression: study protocol for a randomized controlled trial. Trials 2015;16:247. - PMC - PubMed

Additional references

    1. Abdelhamid A, Hooper L, Welch A. Polyunsaturated fatty acids for musculoskeletal health and functional status in older adults. PROSPERO 2017;www.crd.york.ac.uk/prospero/display_record.php?RecordID=79211:CRD4201707....
    1. Abdelhamid AS, Martin N, Bridges C, Brainard JS, Wang X, Brown TJ, et al. Polyunsaturated fatty acids for the primary and secondary prevention of cardiovascular disease. Cochrane Database of Systematic Reviews 2018, Issue 6. [DOI: 10.1002/14651858.CD012345.pub2] - DOI - PMC - PubMed
    1. American Heart Association. Fish and Omega‐3 Fatty Acids. www.heart.org/HEARTORG/HealthyLiving/HealthyEating/HealthyDietGoals/Fish... (accessed 24 November 2017).
    1. Aung T, Halsey J, Kromhout D, Gerstein HC, Marchioli R, Tavazzi L, et al. Associations of omega‐3 fatty acid supplement use with cardiovascular disease risks: meta‐analysis of 10 trials involving 77 917 individuals. JAMA Cardiology 2018;3(3):225‐34. [DOI: 10.1001/jamacardio.2017.5205] - DOI - PMC - PubMed
    1. Balk EM, Adam GP, Langberg V, Halladay C, Chung M, Lin L, et al. Omega‐3 fatty acids and cardiovascular disease: an updated systematic review. Rockville (MD): Agency for Healthcare Research and Quality; 2016. Eviden.... [DOI: 10.23970/AHRQEPCERTA223] - DOI - PubMed

References to other published versions of this review

    1. Hooper L, Harrison RA, Summerbell CD, Moore H, Worthington HV, Ness A, et al. Omega 3 fatty acids for prevention and treatment of cardiovascular disease. Cochrane Database of Systematic Reviews 2004, Issue 4. [DOI: 10.1002/14651858.CD003177.pub2] - DOI - PMC - PubMed
    1. Hooper L, Thompson RL, Harrison RA, Summerbell CD, Ness AR, Moore HJ, et al. Risks and benefits of omega 3 fats for mortality, cardiovascular disease, and cancer: systematic review. BMJ 2006;322:752. [DOI: 10.1136/bmj.38755.366331.2F] - DOI - PMC - PubMed

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