Effect of omega‐3 fatty acids on cardiovascular disease risk: A systematic review and meta‐analysis with meta‐regression

Abstract Objective We aimed to determine if omega‐3 fatty acid (FA) supplementation significantly reduces cardiovascular (CV) events in patients with established CV disease or at high CV risk. Methods We conducted a comprehensive literature search on PubMed, Embase and Cochrane CENTRAL. The results of our analyses were presented as risk ratios (RRs) with 95% confidence intervals (CIs) and pooled using a random effects model. Meta‐regression bubble plots were generated to visualise the results of the analysis, while the detailed results were tabulated. A p ‐value less than‐.05 was considered significant in all cases. Results A total of 42 studies (176 253 participants) were included in our analysis. The pooled analysis demonstrates that omega‐3 FA are associated with a significant reduction in CV mortality ( p =‐.02), CV disease ( p =‐.03), coronary heart disease (CHD) ( p =‐.007), myocardial infarction (MI) ( p =‐.008), fatal MI ( p =‐.0004) and revascularisation ( p =‐.003), and a significant increase in atrial fibrillation ( p =‐.01), and gastrointestinal (GI) adverse events ( p =‐.02). Subgroup analysis demonstrated a significant improvement with EPA monotherapy compared to EPA+DHA combination therapy in the risk of CV mortality ( p = 0.01), CVD events ( p <‐.00001), MACE ( p < .00001), CHD ( p < .00001), MI ( p <‐.00001), fatal MI ( p =‐.004) and revascularisation ( p <‐.0001). EPA monotherapy was associated with a significant increase in the risk of atrial fibrillation ( p =‐.01). Regression analysis demonstrates a dose–response relationship between omega‐3 FA (EPA or EPA+DHA) and CVD events ( p =‐.001), CHD ( p =‐.035), revascularisation ( p =‐.035) and ischemic stroke ( p =‐.003). Conclusion Our study demonstrated a significant reduction in the risk of cardiovascular outcomes with omega‐3 FA administration.