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Research Evidence on Dietary Supplements Omega-3

One report examined how dietary supplements of omega-3 fatty acids affect specific CVD outcomes such as myocardial infarction and stroke and investigated whether these fatty acids can play a role in the primary and secondary prevention of these outcomes. A systematic review of the literature and subsequent screening identified 39 studies that met the investigators' inclusion criteria for reporting mortality or CVD clinical outcomes with a follow-up of at least one year. The primary prevention studies included 22 prospective cohort studies and only one randomized, controlled trial (RCT); they were conducted in countries around the world, most cohorts had several thousand subjects, and studies lasted from 4 to 30 years. The secondary prevention studies, in contrast, consisted of 11 RCTs and one prospective cohort study that reported outcomes on CVD populations; they included over 16,000 patients and lasted from 1.5 to 5 years. Overall, evidence from both the primary and secondary prevention studies supports the hypothesis that consumption of omega-3 fatty acids, fish, and fish oil reduces all-cause mortality and various CVD outcomes such as sudden death, cardiac death, and myocardial infarction. The evidence is strongest for fish or fish oil dietary supplements whereas the potential effects of ALA are largely unknown and the relative effects of ALA versus fish oil are not well defined. In the only RCT that directly compared ALA and fish oil, both treatments reduced CVD outcome. No consistent differences in the effects of omega-3 fatty acids on CVD outcomes were found between men and women, largely because the proportion of women in RCTs was small and data from men and women were not analyzed separately to address any differences. The lessons to be drawn from all these studies to date regarding use of omega-3 fatty acids dietary supplements for preventing and treating CVD are not completely clear. Because the studies involved a variety of methods of estimating fish or omega-3 fatty acid intake, background diets, background risk for heart disease, settings, and methods for reporting results, the validity of applying the results of studies conducted outside the United States to the U.S. population is uncertain. Furthermore, dietary supplements intervention trials are limited by the multiple and complex dietary changes in the trials that make it difficult to distinguish among components and determine which specific components or combinations of these diets are most beneficial. For example, the different types of fish consumed and the method of food preparation may cause different effects.