Meta Analysis:Omega-3Polyunsaturated Fatty Acids In The Intervention And ST2in The Evaluation For Cardiovascular Disease

Background:Patients with impaired glucose metabolism (IGM, including type2diabetes, impaired fasting glucose, or impaired glucose tolerance) are at increased risk for cardiovascular events. Marine-derived n-3polyunsaturated fatty acids (n-3PUFAs), which are found abundantly in fish oil, exert pleiotropic cardiometabolic effects with a diverse range of actions. Epidemiologic studies and several large clinical trials have shown a reduced risk of cardiovascular events among persons who consume fish regularly or who take supplements containing n-3PUFAs.But the impacts of n-3PUFAs on cardiovascular risk in patients with IGM are not well known.Aims:We conducted this meta-analysis to determine the effects of n-3PUFAs on cardiovascular outcomes and cardiovascular risk markers in patients with IGM.Data Sources:We searched PubMed, EMBASE, The Cochrane Library (from the beginning of each database until June2013) and reference lists of relevant papers for high quality randomized controlled trials comparing dietary intake of n-3PUFAs with placebo inIGM patients. We extracted data sets and performed meta-analysis with standardized methods.Data Extraction: Data was extracted and quality assessed independently by two reviewers. Authors were contacted for missing information. The following primary outcomes and cardiovascular risk markers:cardiovascular mortality, major cardiovascular events, all-cause mortality, and composite endpoint of all-cause mortality or hospitalization for cardiovascular cause, triglyceride (TG), total cholesterol (TC), LDL-cholesterol, HDL-cholesterol, HbAlc, fasting plasma glucose (FPG), blood pressure (BP), heart rate (HR), and flow-mediated dilation (FMD).Methods and Results:Our meta-analysis included19studies,24,788patients. Overall estimates were calculated using a random-effects model or a fixed-effects model, and the possibility of publication bias was examined using a funnel plotand the Egger test. Subgroup analyses were conducted to explore the association between the risk markers and study characteristics. Compared with placebo, n-3PUFAs had no statistically significant reduce effect on cardiovascular mortality, major cardiovascular events, all-cause mortality or composite endpoint of all-cause mortality or hospitalization for cardiovascular cause, however it can significantly reduce the level of triglycerides (weighted mean difference [WMD]-0.25mmol/L;95%CI-0.37to-0.13:p<0.001;12trials,13,921patients). Subgroup analysesidentified greater reduction effect on TG in trials with larger doses ofn-3PUFAs (EPA+DHA) and in trials in which patients had higherbaseline HbAlc levels.Significant reduction effect was identifiedonly in trials with larger doses of n-3PUFAs (EPA+DHA)(-0.19mmol/L;95%CI-0.35to-0.04:p=0.016).Conclusion:Marine-derived n-3polyunsaturated fatty acids have no protective effect on cardiovascular mortality, major cardiovascular events, and all-cause mortality and composite endpoint of all-cause mortality or hospitalization for cardiovascular cause in IGM patients, but can reduce triglyceride level.