Clinical trials studying the efficacy of n-3 polyunsaturated fatty acids (PUFA) in
reducing adverse events after acute myocardial infarction (AMI) have yielded conflicting
results, and data regarding the influence of n-3 PUFA treatment after AMI in routine
clinical practice are scarce. We conducted a retrospective observational cohort study
including patients from 5 Italian Local Health Units who were discharged from the
hospital with a primary diagnosis of AMI from January 1, 2010, to December 31, 2011.
Using unique patient identifiers, patients were linked across governmental hospital
discharge, medication prescription, and mortality databases and followed for 12-months
post-index discharge. Patient characteristics and risk of all-cause mortality and
repeat AMI were compared by n-3 PUFA prescription after discharge (for outcome analyses,
defined as ≥2 prescriptions) at a presumed dose of 1 g/day. Overall, 11,269 patients
met inclusion criteria, of which 2,425 patients (21.5%) were prescribed n-3 PUFA during
follow-up. Patients treated with n-3 PUFA tended to be younger, men, and carry a diagnosis
of diabetes and were more likely to be receiving guideline-recommended post-AMI medical
therapy, including β blockers, angiotensin-converting enzyme inhibitors/angiotensin
II receptor blockers, statins, and antiplatelet therapy (all p <0.001). After adjusting
for patient characteristics and concurrent therapies, n-3 PUFA treatment was associated
with reduced all-cause mortality (hazard ratio 0.76, 95% CI 0.59 to 0.97) and recurrent
AMI (hazard ratio 0.65, 95% CI 0.49 to 0.87) through 12-month follow-up. In conclusion,
in this large, contemporary, observational study of “real-world” Italian patients
hospitalized for AMI, the use of n-3 PUFA was independently associated with a robust
reduction in all-cause mortality and recurrent AMI. These data support further randomized
controlled trials with n-3 PUFA therapy in the post-AMI setting.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to American Journal of CardiologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Dietary supplementation with n-3 polyunsaturated fatty acids and vitamin E after myocardial infarction: results of the GISSI-Prevenzione trial. Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto miocardico.Lancet. 1999; 354: 447-455
- Early protection against sudden death by n-3 polyunsaturated fatty acids after myocardial infarction: time-course analysis of the results of the Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico (GISSI)-Prevenzione.Circulation. 2002; 105: 1897-1903
- Alpha Omega trial group. n-3 fatty acids and cardiovascular events after myocardial infarction.N Engl J Med. 2010; 363: 2015-2026
- OMEGA, a randomized, placebo-controlled trial to test the effect of highly purified omega-3 fatty acids on top of modern guideline-adjusted therapy after myocardial infarction.Circulation. 2010; 122: 2152-2159
- Effects of B vitamins and omega 3 fatty acids on cardiovascular diseases: a randomised placebo controlled trial.BMJ. 2010; 341: c6273
- International comparisons of the management of patients with non-ST segment elevation acute myocardial infarction in the United Kingdom, Sweden, and the United States: the MINAP/NICOR, SWEDEHEART/RIKS-HIA, and ACTION Registry-GWTG/NCDR registries.Int J Cardiol. 2014; 175: 240-247
- Prevalence, predictors, and impact of conservative medical management for patients with non-ST-segment elevation acute coronary syndromes who have angiographically documented significant coronary disease.JACC Cardiovasc Interv. 2008; 1: 369-378
- Regional patterns of use of a medical management strategy for patients with non-ST-segment elevation acute coronary syndromes: insights from the EARLY ACS trial.Circ Cardiovasc Qual Outcomes. 2012; 5: 205-213
- Relationship between adherence to evidence-based pharmacotherapy and long-term mortality after acute myocardial infarction.JAMA. 2007; 297: 177-186
- Impact of medication therapy discontinuation on mortality after myocardial infarction.Arch Intern Med. 2006; 166: 1842-1847
- Effect of purified omega-3 fatty acids on reducing left ventricular remodeling after acute myocardial infarction (OMEGA-REMODEL study): a double-blind randomized clinical trial.J Cardiovasc Magn Reson. 2015; 17: 7
- Association between omega-3 fatty acid supplementation and risk of major cardiovascular disease events: a systematic review and meta-analysis.JAMA. 2012; 308: 1024-1033
- Long chain omega-3 fatty acids and cardiovascular disease: a systematic review.Br J Nutr. 2012; 107: S201-S213
- Trajectories of risk after hospitalization for heart failure, acute myocardial infarction, or pneumonia: retrospective cohort study.BMJ. 2015; 350: h411
- Omega-3 polyunsaturated fatty acids and cardiovascular diseases.J Am Coll Cardiol. 2009; 54: 585-594
- Cardiovascular care facts: a report from the national cardiovascular data registry: 2011.J Am Coll Cardiol. 2013; 62: 1931-1947
- 2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes: a report of the American college of Cardiology/American heart association Task Force on Practice Guidelines.J Am Coll Cardiol. 2014; 64: e139-e228
- 2009 focused updates: ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction (updating the 2004 guideline and 2007 focused update) and ACC/AHA/SCAI guidelines on percutaneous coronary intervention (updating the 2005 guideline and 2007 focused update) a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines.J Am Coll Cardiol. 2009; 54: 2205-2241
- Exploratory analysis on the use of statins with or without n-3 PUFA and major events in patients discharged for acute myocardial infarction: an observational retrospective study.PloS One. 2013; 8: e62772
- Stabilizing effect of combined eicosapentaenoic acid and statin therapy on coronary thin-cap fibroatheroma.Atherosclerosis. 2014; 234: 114-119
- The imperative of overcoming barriers to the conduct of large, simple trials.JAMA. 2014; 311: 1397-1398
- Rescuing clinical trials in the United States and beyond: a call for action.Am Heart J. 2013; 165: 837-847
- Thrombus aspiration during ST-segment elevation myocardial infarction.N Engl J Med. 2013; 369: 1587-1597
- A registry-based randomized trial comparing radial and femoral approaches in women undergoing percutaneous coronary intervention: the SAFE-PCI for Women (Study of Access Site for Enhancement of PCI for Women) trial.JACC Cardiovasc Interv. 2014; 7: 857-867
Article Info
Publication History
Published online: November 17, 2015
Accepted:
October 30,
2015
Received in revised form:
October 30,
2015
Received:
September 6,
2015
Footnotes
The study was funded by Sigma-Tau Pharmaceuticals . (Pomezia, Italy)
Dr. Nodari had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
See page 345 for disclosure information.
Identification
Copyright
© 2016 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
