No effect of n-3 fatty acids supplementation on NT-proBNP after myocardial infarction: the Alpha Omega Trial

Eur J Prev Cardiol. 2015 May;22(5):648-55. doi: 10.1177/2047487314536694. Epub 2014 May 30.


Background: heart failure is a major risk factor for cardiovascular mortality, for which n-3 fatty acids may have beneficial effects. We examined the effect of marine eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), and plant-derived alpha-linolenic acid (ALA) on N-Terminal-pro Brain Natriuretic Peptide (NT-proBNP), a biomarker of heart failure.

Methods: we randomly assigned 4837 post-myocardial infarction patients, aged 60-80 years (82% men), to margarines supplemented with a targeted additional intake of 400 mg/day EPA and DHA, 2 g/day ALA, EPA-DHA plus ALA, or placebo for 40 months. In a random selection of 639 patients, NT-proBNP was determined both at baseline and at the end of follow-up. NT-proBNP was loge-transformed and analysed by type of treatment using analysis of covariance adjusting for baseline NT-proNBP.

Results: patients consumed on average 19.8 g margarine/day, providing an additional amount of 238 mg/day EPA with 158 mg/day DHA, 1.98 g/day ALA, or both, in the active-treatment groups. In the placebo group, the geometric mean level NT-proBNP increased from 245 ng/l (95%-confidence interval [CI]: 207-290) to 294 ng/l (95%-CI: 244-352) after 40 months (p = 0.001). NT-proBNP levels were not affected by ALA (+8% versus placebo; 95%-CI: -8% to +25%; p = 0.34), EPA-DHA (+2% versus placebo; 95%-CI: -14% to +18%; p = 0.78), nor EPA-DHA plus ALA (+9% versus placebo; 95%-CI: -8% to +25%; p = 0.31) treatment.

Conclusions: supplementation with modest amounts of EPA-DHA, with or without ALA, did not have a significant effect on NT-proBNP levels in patients with a history of myocardial infarction.

Trial registration: NCT00127452.

Keywords: NT-proBNP; alpha-linolenic acid; docosahexaenoic acid; eicosapentaenoic acid; n-3 Polyunsaturated fatty acids; randomized double-blind placebo-controlled trial.

Publication types

  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural

MeSH terms

  • Aged
  • Aged, 80 and over
  • Biomarkers / blood
  • Fatty Acids, Omega-3 / administration & dosage*
  • Female
  • Heart Failure / diagnosis
  • Humans
  • Male
  • Margarine*
  • Middle Aged
  • Myocardial Infarction / blood
  • Myocardial Infarction / diet therapy*
  • Natriuretic Agents / blood*
  • Natriuretic Peptide, Brain / blood*
  • Peptide Fragments / blood*
  • Random Allocation


  • Biomarkers
  • Fatty Acids, Omega-3
  • Natriuretic Agents
  • Peptide Fragments
  • pro-brain natriuretic peptide (1-76)
  • Natriuretic Peptide, Brain
  • Margarine

Associated data