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Meta-Analysis
. 2018 Dec;97(50):e13593.
doi: 10.1097/MD.0000000000013593.

Comparison of efficacy and safety of combination therapy with statins and omega-3 fatty acids versus statin monotherapy in patients with dyslipidemia: A systematic review and meta-analysis

Hye Duck Choi  1 , Seung Min Chae
Affiliations
Meta-Analysis

Comparison of efficacy and safety of combination therapy with statins and omega-3 fatty acids versus statin monotherapy in patients with dyslipidemia: A systematic review and meta-analysis

Hye Duck Choi et al. Medicine (Baltimore). 2018 Dec.

Abstract

Objective: Dyslipidemia is a major risk factor for the development of cardiovascular disease. Both statins and omega-3 fatty acids demonstrate beneficial effects on lipid concentrations. The goal was to evaluate the safety and efficacy of combination therapy with statins and omega-3 fatty acids.

Methods: We performed a systematic review and meta-analysis of published data to compare the safety and efficacy of combination therapy with statins and omega-3 fatty acids versus statin monotherapy in patients with dyslipidemia. Six articles were assessed in the present meta-analysis (quantitative assessment) and qualitative assessment.

Results: In terms of efficacy, the combination treatment afforded a significantly greater reduction in total cholesterol/high-density lipoprotein cholesterol than statin alone did [standard difference in means = -0.215; 95% confidence interval (CI) -0.359--0.071]. However, there was no significant difference in low-density lipoprotein (LDL) cholesterol between the 2 groups. Qualitative assessment of other lipid parameters was performed. Combination therapy with statins and omega-3 fatty acids was generally more effective on lipid concentration than statin monotherapy. In terms of safety, there were no significant differences in total adverse events between the 2 groups. Gastrointestinal adverse events were found to be significantly increased in patients receiving combination therapy using the fixed-effects model (relative risk = 0.547; 95% CI 0.368-0.812).

Conclusions: We suggest that combination therapy with statins and omega-3 fatty acids enhances lipid profile, except LDL cholesterol, compared with statin monotherapy. Nevertheless, statin and omega-3 fatty acid combination should be cautiously recommended, taking into account the clinical importance of LDL cholesterol and safety issues associated with their concomitant use.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
PRISMA diagram of the process of selecting relevant studies.
Figure 2
Figure 2
Forest plot of efficacy. Changes in low-density lipoprotein (LDL) cholesterol (A) and total cholesterol/high-density lipoprotein, (HDL) cholesterol ratio (B) compared between statin monotherapy and combination therapy with omega-3 fatty acid.
Figure 3
Figure 3
Forest plot of safety. Total adverse events (A) and gastrointestinal adverse events (B) compared between statin monotherapy and combination therapy with omega-3 fatty acids. CI = confidence interval.
See this image and copyright information in PMC

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