• Intervention
    What biomarkers of Omega-3 fatty acids have been associated with a reduced risk of mortality?
    • Conclusion

      Unpublished June 12, 2011  [2005 Omega-3 question not used in 2011 guideline]

      Increased plasma levels, adipose tissue and cholesterol ester concentrations of a-linolenic acid, EPA and DHA have been associated with reduced risk of mortality.

    • Grade: II
      • Grade I means there is Good/Strong evidence supporting the statement;
      • Grade II is Fair;
      • Grade III is Limited/Weak;
      • Grade IV is Expert Opinion Only;
      • Grade V is Not Assignable.
      • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
      • Moderate (B) means we are moderately confident in the effect estimate;
      • Low (C) means our confidence in the effect estimate is limited;
      • Very Low (D) means we have very little confidence in the effect estimate.
      • Ungraded means a grade is not assignable.
    What is the relationship between fish-derived omega-3 fatty acids and the risk of CHD in individuals without prior heart disease?
    • Conclusion

      Epidemiological studies indicate that regular consumption of an average of two servings of fatty fish per week (about 3.5 oz per serving) [high in long chain n-3 fatty acids, such as eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA)] is associated with a 30 – 40% reduced risk of death from cardiac events in subjects without prior disease.

    • Grade: II
      • Grade I means there is Good/Strong evidence supporting the statement;
      • Grade II is Fair;
      • Grade III is Limited/Weak;
      • Grade IV is Expert Opinion Only;
      • Grade V is Not Assignable.
      • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
      • Moderate (B) means we are moderately confident in the effect estimate;
      • Low (C) means our confidence in the effect estimate is limited;
      • Very Low (D) means we have very little confidence in the effect estimate.
      • Ungraded means a grade is not assignable.
    What is the relationship between omega-3 fatty acids and sudden cardiac death in patients with angina?
    • Conclusion

      One recent study of moderate quality has shown no protective effect of fish in patients with angina (n=1109). However, the fish oil supplemented group with angina in this study (3 grams per week, n=462) showed significantly higher cardiac death and sudden death (p<.05). There is insufficient research to indicate whether the harm associated with fish oil supplement intake by angina patients is a result of the difference between fish and supplement intervention or special population characteristics.

    • Grade: III
      • Grade I means there is Good/Strong evidence supporting the statement;
      • Grade II is Fair;
      • Grade III is Limited/Weak;
      • Grade IV is Expert Opinion Only;
      • Grade V is Not Assignable.
      • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
      • Moderate (B) means we are moderately confident in the effect estimate;
      • Low (C) means our confidence in the effect estimate is limited;
      • Very Low (D) means we have very little confidence in the effect estimate.
      • Ungraded means a grade is not assignable.
    What is the relationship between plant-derived omega-3 fatty acids and the risk of death from cardiac events?
    • Conclusion

      Epidemiological studies indicate that inclusion of vegetable oils and food sources high in a-linolenic acid, resulting in a total intake of more than 1.5 g/day, is associated with a 40 – 65% reduced risk of death from cardiac events.

    • Grade: III
      • Grade I means there is Good/Strong evidence supporting the statement;
      • Grade II is Fair;
      • Grade III is Limited/Weak;
      • Grade IV is Expert Opinion Only;
      • Grade V is Not Assignable.
      • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
      • Moderate (B) means we are moderately confident in the effect estimate;
      • Low (C) means our confidence in the effect estimate is limited;
      • Very Low (D) means we have very little confidence in the effect estimate.
      • Ungraded means a grade is not assignable.
    What is the relationship between supplement or fish-derived EPA and DHA (omega-3 fatty acids) and the risk of death from cardiac events in patients with heart disease?
    • Conclusion

      Randomized clinical trials have shown that approximately one gram per day of EPA and DHA from a supplement or fish decreases the risk of death from cardiac events in patients with heart disease.

    • Grade: II
      • Grade I means there is Good/Strong evidence supporting the statement;
      • Grade II is Fair;
      • Grade III is Limited/Weak;
      • Grade IV is Expert Opinion Only;
      • Grade V is Not Assignable.
      • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
      • Moderate (B) means we are moderately confident in the effect estimate;
      • Low (C) means our confidence in the effect estimate is limited;
      • Very Low (D) means we have very little confidence in the effect estimate.
      • Ungraded means a grade is not assignable.