Post-Heart Attack Therapy: Omega-3s Reduce Deaths and Recurrences

In subjects who have survived an acute myocardial infarction, treatment with omega-3 is associated with a 24% reduction in mortality and a 35% reduction in recurrences. This conclusion supports the results of other recent clinical studies, helping to clarify the protective role of EPA and DHA therapy in the post-infarction period.

This is demonstrated by a large study conducted in Italy by researchers at the University of Brescia and published in the American Journal of Cardiology.

Need for “Real World” Studies

The results confirm those of an important Italian study, the GISSI-Prevenzione trial, which in 1999 showed that in patients surviving a heart attack, treatment with 1 gram per day of omega-3 reduced the risk of death, recurrence, and stroke. Despite other research highlighting the beneficial role, skepticism remains about omega-3 therapy following a heart attack, due to insufficient data on this type of treatment and conflicting results from some studies. As explained by the authors from the University of Brescia, the heterogeneity of observed effects is likely due to some limitations of the randomized controlled trials (RCTs) conducted so far.

RCTs include selected populations, excluding those with other diseases or particular health conditions, and are conducted over limited treatment and observation periods. What emerges from RCTs is not always generalizable to real clinical settings where, among other things, adherence to guideline treatments is generally lower. Regarding omega-3 supplementation studies, doses used have often been very low compared to some recent works, such as OMEGA-REMODEL, where administration of 4 grams of omega-3 within 1 month after infarction favored left ventricular remodeling and reduced inflammation.

For these reasons, the Italian researchers saw the need for a “Real World” study considering data from medical records of real patients with their own clinical history, allowing information on a large number of subjects and over long time periods.

Relationship Found Between Omega-3 and Reduced Risk of New Heart Attack

The reassessment of the role of omega-3 in post-infarction patients recently discharged from hospital within the Real World context took into account patient characteristics and concomitant therapies. Results showed that omega-3 treatment was strongly associated with a 35% reduction in the risk of new heart attack and a 24% reduction in all-cause mortality.

These data were observed despite about half of the omega-3 treated subjects not fully adhering to the therapy, showing maximum adherence of 80%. Furthermore, the study found that the beneficial effects of omega-3 on infarct recurrence were evident only in patients who had taken statins, common cholesterol-lowering drugs, suggesting an interaction between specific therapies and omega-3.

Details of the Study

This study was the first conducted in Italy using real clinical data on a large number of patients who survived a heart attack. To carry it out, researchers used administrative databases from 5 Local Health Units (USL). Included were those discharged from hospital with a primary diagnosis of acute myocardial infarction between January 2010 and December 2011. For each patient, information on hospital discharge, prescribed medications, and any mortality was identified. Participants were then followed for 12 months after discharge. In total, 11,269 patients were included, with a mean age of 69 years; among them, 2,425 had taken omega-3. Patient characteristics and mortality and new infarction risk were related to the daily prescription of 1 gram of omega-3 after discharge. Patients treated with fatty acids were generally younger, male, and diabetic. Compared to others, they had a higher likelihood of following post-infarction medical therapy recommended by guidelines, including beta-blockers, statins, and antiplatelet drugs.

Omega-3 as Supportive Therapy

According to the study authors, this research highlights a strong independent association of omega-3 treatment with reduced mortality and recurrences in post-infarction survivors. As the researchers emphasized, this does not suggest any changes to the medical therapies currently recommended but supports the hypothesis that omega-3 may enhance the effect of statins, improving patient survival and reducing re-hospitalizations.

 Source: Greene SJ, Temporelli PL, Campia U, et al. Effects of Polyunsaturated Fatty Acid Treatment on Postdischarge Outcomes After Acute Myocardial Infarction. Am J Cardiol, 2015 Nov 18.