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Review
. 2018 Jul 18;7(7):CD003177.
doi: 10.1002/14651858.CD003177.pub3.

Omega-3 Fatty Acids for the Primary and Secondary Prevention of Cardiovascular Disease

Affiliations
Free PMC article
Review

Omega-3 Fatty Acids for the Primary and Secondary Prevention of Cardiovascular Disease

Asmaa S Abdelhamid et al. Cochrane Database Syst Rev. .
Free PMC article

Update in

Abstract

Background: Researchers have suggested that omega-3 polyunsaturated fatty acids from oily fish (long-chain omega-3 (LCn3), including eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA)), as well as from plants (alpha-linolenic acid (ALA)) benefit cardiovascular health. Guidelines recommend increasing omega-3-rich foods, and sometimes supplementation, but recent trials have not confirmed this.

Objectives: To assess effects of increased intake of fish- and plant-based omega-3 for all-cause mortality, cardiovascular (CVD) events, adiposity and lipids.

Search methods: We searched CENTRAL, MEDLINE and Embase to April 2017, plus ClinicalTrials.gov and World Health Organization International Clinical Trials Registry to September 2016, with no language restrictions. We handsearched systematic review references and bibliographies and contacted authors.

Selection criteria: We included randomised controlled trials (RCTs) that lasted at least 12 months and compared supplementation and/or advice to increase LCn3 or ALA intake versus usual or lower intake.

Data collection and analysis: Two review authors independently assessed studies for inclusion, extracted data and assessed validity. We performed separate random-effects meta-analysis for ALA and LCn3 interventions, and assessed dose-response relationships through meta-regression.

Main results: We included 79 RCTs (112,059 participants) in this review update and found that 25 were at low summary risk of bias. Trials were of 12 to 72 months' duration and included adults at varying cardiovascular risk, mainly in high-income countries. Most studies assessed LCn3 supplementation with capsules, but some used LCn3- or ALA-rich or enriched foods or dietary advice compared to placebo or usual diet.Meta-analysis and sensitivity analyses suggested little or no effect of increasing LCn3 on all-cause mortality (RR 0.98, 95% CI 0.90 to 1.03, 92,653 participants; 8189 deaths in 39 trials, high-quality evidence), cardiovascular mortality (RR 0.95, 95% CI 0.87 to 1.03, 67,772 participants; 4544 CVD deaths in 25 RCTs), cardiovascular events (RR 0.99, 95% CI 0.94 to 1.04, 90,378 participants; 14,737 people experienced events in 38 trials, high-quality evidence), coronary heart disease (CHD) mortality (RR 0.93, 95% CI 0.79 to 1.09, 73,491 participants; 1596 CHD deaths in 21 RCTs), stroke (RR 1.06, 95% CI 0.96 to 1.16, 89,358 participants; 1822 strokes in 28 trials) or arrhythmia (RR 0.97, 95% CI 0.90 to 1.05, 53,796 participants; 3788 people experienced arrhythmia in 28 RCTs). There was a suggestion that LCn3 reduced CHD events (RR 0.93, 95% CI 0.88 to 0.97, 84,301 participants; 5469 people experienced CHD events in 28 RCTs); however, this was not maintained in sensitivity analyses - LCn3 probably makes little or no difference to CHD event risk. All evidence was of moderate GRADE quality, except as noted.Increasing ALA intake probably makes little or no difference to all-cause mortality (RR 1.01, 95% CI 0.84 to 1.20, 19,327 participants; 459 deaths, 5 RCTs),cardiovascular mortality (RR 0.96, 95% CI 0.74 to 1.25, 18,619 participants; 219 cardiovascular deaths, 4 RCTs), and it may make little or no difference to CHD events (RR 1.00, 95% CI 0.80 to 1.22, 19,061 participants, 397 CHD events, 4 RCTs, low-quality evidence). However, increased ALA may slightly reduce risk of cardiovascular events (from 4.8% to 4.7%, RR 0.95, 95% CI 0.83 to 1.07, 19,327 participants; 884 CVD events, 5 RCTs, low-quality evidence), and probably reduces risk of CHD mortality (1.1% to 1.0%, RR 0.95, 95% CI 0.72 to 1.26, 18,353 participants; 193 CHD deaths, 3 RCTs), and arrhythmia (3.3% to 2.6%, RR 0.79, 95% CI 0.57 to 1.10, 4,837 participants; 141 events, 1 RCT). Effects on stroke are unclear.Sensitivity analysis retaining only trials at low summary risk of bias moved effect sizes towards the null (RR 1.0) for all LCn3 primary outcomes except arrhythmias, but for most ALA outcomes, effect sizes moved to suggest protection. LCn3 funnel plots suggested that adding in missing studies/results would move effect sizes towards null for most primary outcomes. There were no dose or duration effects in subgrouping or meta-regression.There was no evidence that increasing LCn3 or ALA altered serious adverse events, adiposity or lipids, although LCn3 slightly reduced triglycerides and increased HDL. ALA probably reduces HDL (high- or moderate-quality evidence).

Authors' conclusions: This is the most extensive systematic assessment of effects of omega-3 fats on cardiovascular health to date. Moderate- and high-quality evidence suggests that increasing EPA and DHA has little or no effect on mortality or cardiovascular health (evidence mainly from supplement trials). Previous suggestions of benefits from EPA and DHA supplements appear to spring from trials with higher risk of bias. Low-quality evidence suggests ALA may slightly reduce CVD event risk, CHD mortality and arrhythmia.

Conflict of interest statement

ASA: none known. TJB: none known. JSB: none known. PB: none known. GCT: none known. HJM: none known. KHOD: none known. FKA: none known. CDS: none known. HVW: none known. FS: none known. LH: none known.

Figures

Figure 1
Figure 1
Study flow diagram.
Figure 2
Figure 2
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Figure 3
Figure 3
Funnel plot of comparison: 1 High vs low LCn3 omega‐3 fats (primary outcomes), outcome: 1.1 Aall‐cause mortality (overall) – LCn3.
Figure 4
Figure 4
Funnel plot of comparison: 1 High vs low LCn3 omega‐3 fats (primary outcomes), outcome: 1.11 Cardiovascular mortality (overall) – LCn3.
Figure 5
Figure 5
Funnel plot of comparison: 1 High vs low LCn3 omega‐3 fats (primary outcomes), outcome: 1.31 Coronary heart disease mortality (overall) – LCn3.
Figure 6
Figure 6
Funnel plot of comparison: 1 High vs low LCn3 omega‐3 fats (primary outcomes), outcome: 1.43 Coronary heart disease events (overall) – LCn3.
Analysis 1.1
Analysis 1.1
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 1 All‐cause mortality (overall) ‐ LCn3.
Analysis 1.2
Analysis 1.2
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 2 All‐cause mortality ‐ LCn3 ‐ sensitivity analysis (SA) fixed‐effect.
Analysis 1.3
Analysis 1.3
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 3 All‐cause mortality ‐ LCn3 ‐ SA by summary risk of bias.
Analysis 1.4
Analysis 1.4
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 4 All‐cause mortality ‐ LCn3 ‐ SA by compliance and study size.
Analysis 1.5
Analysis 1.5
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 5 All‐cause mortality ‐ LCn3 ‐ subgroup by dose.
Analysis 1.6
Analysis 1.6
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 6 All‐cause mortality ‐ LCn3 ‐ subgroup by replacement.
Analysis 1.7
Analysis 1.7
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 7 All‐cause mortality ‐ LCn3 ‐ subgroup by intervention type.
Analysis 1.8
Analysis 1.8
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 8 All‐cause mortality ‐ LCn3 ‐ subgroup by duration.
Analysis 1.9
Analysis 1.9
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 9 All‐cause mortality ‐ LCn3 ‐ subgroup by primary or secondary prevention.
Analysis 1.10
Analysis 1.10
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 10 All‐cause mortality ‐ LCn3 ‐ subgroup by statin use.
Analysis 1.11
Analysis 1.11
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 11 Cardiovascular mortality (overall) ‐ LCn3.
Analysis 1.12
Analysis 1.12
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 12 CVD mortality ‐ LCn3 ‐ SA fixed‐effect.
Analysis 1.13
Analysis 1.13
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 13 CVD mortality ‐ LCn3 ‐ SA by summary risk of bias.
Analysis 1.14
Analysis 1.14
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 14 CVD mortality ‐ LCn3 ‐ SA by compliance and study size.
Analysis 1.15
Analysis 1.15
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 15 CVD mortality ‐ LCn3 ‐ subgroup by dose.
Analysis 1.16
Analysis 1.16
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 16 CVD mortality ‐ LCn3 ‐ subgroup by replacement.
Analysis 1.17
Analysis 1.17
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 17 CVD mortality ‐ LCn3 ‐ subgroup by intervention type.
Analysis 1.18
Analysis 1.18
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 18 CVD mortality ‐ LCn3 ‐ subgroup by duration.
Analysis 1.19
Analysis 1.19
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 19 CVD mortality ‐ LCn3 ‐ subgroup by primary or secondary prevention.
Analysis 1.20
Analysis 1.20
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 20 CVD mortality ‐ LCn3 ‐ subgroup by statin uses.
Analysis 1.21
Analysis 1.21
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 21 Cardiovascular events (overall) ‐ LCn3.
Analysis 1.22
Analysis 1.22
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 22 CVD events ‐ LCn3 ‐ SA fixed‐effect.
Analysis 1.23
Analysis 1.23
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 23 CVD events ‐ LCn3 ‐ SA by summary risk of bias.
Analysis 1.24
Analysis 1.24
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 24 CVD events ‐ LCn3 ‐ SA by compliance and study size.
Analysis 1.25
Analysis 1.25
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 25 CVD events ‐ LCn3 ‐ subgroup by dose.
Analysis 1.26
Analysis 1.26
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 26 CVD events ‐ LCn3 ‐ subgroup by replacement.
Analysis 1.27
Analysis 1.27
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 27 CVD events ‐ LCn3 ‐ subgroup by intervention type.
Analysis 1.28
Analysis 1.28
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 28 CVD events ‐ LCn3 ‐ subgroup by duration.
Analysis 1.29
Analysis 1.29
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 29 CVD events ‐ LCn3 ‐ subgroup by primary or secondary prevention.
Analysis 1.30
Analysis 1.30
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 30 CVD events ‐ LCn3 ‐ subgroup by statin use.
Analysis 1.31
Analysis 1.31
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 31 Coronary heart disease mortality (overall) ‐ LCn3.
Analysis 1.32
Analysis 1.32
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 32 CHD mortality ‐ LCn3 ‐ SA fixed‐effect.
Analysis 1.33
Analysis 1.33
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 33 CHD mortality ‐ LCn3 ‐ SA by summary risk of bias.
Analysis 1.34
Analysis 1.34
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 34 CHD mortality ‐ LCn3 ‐ SA by compliance and study size.
Analysis 1.35
Analysis 1.35
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 35 CHD mortality ‐ LCn3 ‐ SA omitting cardiac death.
Analysis 1.36
Analysis 1.36
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 36 CHD mortality ‐ LCn3 ‐ subgroup by dose.
Analysis 1.37
Analysis 1.37
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 37 CHD mortality ‐ LCn3 ‐ subgroup by replacement.
Analysis 1.38
Analysis 1.38
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 38 CHD mortality ‐ LCn3 ‐ subgroup by intervention type.
Analysis 1.39
Analysis 1.39
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 39 CHD mortality ‐ LCn3 ‐ subgroup by duration.
Analysis 1.40
Analysis 1.40
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 40 CHD mortality ‐ LCn3 ‐ subgroup by primary or secondary prevention.
Analysis 1.41
Analysis 1.41
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 41 CHD mortality ‐ LCn3 ‐ subgroup by statin use.
Analysis 1.42
Analysis 1.42
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 42 CHD mortality ‐ LCn3 ‐ subgroup by CAD history.
Analysis 1.43
Analysis 1.43
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 43 Coronary heart disease events (overall) ‐ LCn3.
Analysis 1.44
Analysis 1.44
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 44 CHD events ‐ LCn3 ‐ SA fixed‐effect.
Analysis 1.45
Analysis 1.45
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 45 CHD events ‐ LCn3 ‐ SA by summary risk of bias.
Analysis 1.46
Analysis 1.46
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 46 CHD events ‐ LCn3 ‐ SA by compliance and study size.
Analysis 1.47
Analysis 1.47
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 47 CHD events ‐ LCn3 ‐ subgroup by dose.
Analysis 1.48
Analysis 1.48
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 48 CHD events ‐ LCn3 ‐ subgroup by replacement.
Analysis 1.49
Analysis 1.49
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 49 CHD events ‐ LCn3 ‐ subgroup by intervention type.
Analysis 1.50
Analysis 1.50
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 50 CHD events ‐ LCn3 ‐ subgroup by duration.
Analysis 1.51
Analysis 1.51
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 51 CHD events ‐ LCn3 ‐ subgroup by primary or secondary prevention.
Analysis 1.52
Analysis 1.52
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 52 CHD events ‐ LCn3 ‐ subgroup by statin use.
Analysis 1.53
Analysis 1.53
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 53 CHD events ‐ LCn3 subgroup by CAD history.
Analysis 1.54
Analysis 1.54
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 54 Stroke (overall) ‐ LCn3.
Analysis 1.55
Analysis 1.55
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 55 Stroke ‐ LCn3 ‐ SA fixed‐effect.
Analysis 1.56
Analysis 1.56
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 56 Stroke ‐ LCn3 ‐ SA by summary risk of bias.
Analysis 1.57
Analysis 1.57
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 57 Stroke ‐ LCn3 ‐ SA by compliance and study size.
Analysis 1.58
Analysis 1.58
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 58 Stroke ‐ LCn3 ‐ subgroup by stroke type.
Analysis 1.59
Analysis 1.59
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 59 Stroke ‐ LCn3 ‐ subgroup by dose.
Analysis 1.60
Analysis 1.60
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 60 Stroke ‐ LCn3 ‐ subgroup by replacement.
Analysis 1.61
Analysis 1.61
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 61 Stroke ‐ LCn3 ‐ subgroup by intervention type.
Analysis 1.62
Analysis 1.62
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 62 Stroke ‐ LCn3 ‐ subgroup by duration.
Analysis 1.63
Analysis 1.63
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 63 Stroke ‐ LCn3 ‐ subgroup by primary or secondary prevention.
Analysis 1.64
Analysis 1.64
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 64 Stroke ‐ LCn3 ‐ subgroup by statin use.
Analysis 1.65
Analysis 1.65
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 65 Arrythmia (overall) ‐ LCn3.
Analysis 1.66
Analysis 1.66
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 66 Arrhythmia‐ LCn3 ‐ SA fixed‐effect.
Analysis 1.67
Analysis 1.67
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 67 Arrhythmia‐ LCn3 ‐ SA by summary risk of bias.
Analysis 1.68
Analysis 1.68
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 68 Arrhythmia‐ LCn3 ‐ SA by compliance and study size.
Analysis 1.69
Analysis 1.69
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 69 Arrhythmia ‐ LCn3 ‐ subgroup by new or recurrent.
Analysis 1.70
Analysis 1.70
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 70 Arrhythmia ‐ LCn3 ‐ subgroup by fatality.
Analysis 1.71
Analysis 1.71
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 71 Arrhythmia ‐ LCn3 ‐ subgroup by dose.
Analysis 1.72
Analysis 1.72
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 72 Arrhythmia ‐ LCn3 ‐ subgroup by replacement.
Analysis 1.73
Analysis 1.73
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 73 Arrhythmia ‐ LCn3 ‐ subgroup by intervention type.
Analysis 1.74
Analysis 1.74
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 74 Arrhythmia ‐ LCn3 ‐ subgroup by duration.
Analysis 1.75
Analysis 1.75
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 75 Arrhythmia ‐ LCn3 ‐ subgroup by primary or secondary prevention3.
Analysis 1.76
Analysis 1.76
Comparison 1 High vs low LCn3 omega‐3 fats (primary outcomes), Outcome 76 Arrhythmia ‐ LCn3 ‐ subgroup by statin use.
Analysis 2.1
Analysis 2.1
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 1 MACCEs ‐ LCn3.
Analysis 2.2
Analysis 2.2
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 2 Myocardial infarction (overall) ‐ LCn3.
Analysis 2.3
Analysis 2.3
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 3 Total MI ‐ sensitivity analysis (SA) by summary risk of bias.
Analysis 2.4
Analysis 2.4
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 4 Total MI ‐ LCn3 ‐ SA by compliance and study size.
Analysis 2.5
Analysis 2.5
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 5 Total MI ‐ LCn3 ‐ subgroup by fatality.
Analysis 2.6
Analysis 2.6
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 6 Sudden cardiac death (overall) ‐ LCn3.
Analysis 2.7
Analysis 2.7
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 7 Angina ‐ LCn3.
Analysis 2.8
Analysis 2.8
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 8 Heart failure ‐ LCn3.
Analysis 2.9
Analysis 2.9
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 9 Revascularisation ‐ LCn3.
Analysis 2.10
Analysis 2.10
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 10 Peripheral arterial disease ‐ LCn3.
Analysis 2.11
Analysis 2.11
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 11 PAD ‐ LCn3 ‐ SA by summary risk of bias.
Analysis 2.12
Analysis 2.12
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 12 PAD ‐ LCn3 ‐ SA compliance and study size.
Analysis 2.13
Analysis 2.13
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 13 Acute coronary syndrome ‐ LCn3.
Analysis 2.14
Analysis 2.14
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 14 Body weight, kg ‐ LCn3.
Analysis 2.15
Analysis 2.15
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 15 Weight, kg ‐ LCn3 ‐ SA by summary risk of bias.
Analysis 2.16
Analysis 2.16
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 16 Weight, kg ‐ LCn3 ‐ SA by compliance and study size.
Analysis 2.17
Analysis 2.17
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 17 Weight, kg ‐ LCn3 ‐ subgroup by dose.
Analysis 2.18
Analysis 2.18
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 18 Weight, kg ‐ LCn3 ‐ subgroup by replacement.
Analysis 2.19
Analysis 2.19
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 19 Weight, kg ‐ LCn3 ‐ subgroup by intervention type.
Analysis 2.20
Analysis 2.20
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 20 Weight, kg ‐ LCn3 ‐ subgroup by duration.
Analysis 2.21
Analysis 2.21
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 21 Weight, kg ‐ LCn3 ‐ subgroup by primary or secondary prevention.
Analysis 2.22
Analysis 2.22
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 22 Weight, kg ‐ LCn3 ‐ subgroup by statin use.
Analysis 2.23
Analysis 2.23
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 23 Body mass index, kg/m² ‐ LCn3.
Analysis 2.24
Analysis 2.24
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 24 BMI, kg/m²‐ LCn3 ‐ SA by summary risk of bias.
Analysis 2.25
Analysis 2.25
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 25 BMI, kg/m²‐ LCn3 ‐ SA by compliance and study size.
Analysis 2.26
Analysis 2.26
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 26 BMI, kg/m² ‐ LCn3 ‐ subgroup by dose.
Analysis 2.27
Analysis 2.27
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 27 BMI, kg/m² ‐ LCn3 ‐ subgroup by replacement.
Analysis 2.28
Analysis 2.28
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 28 BMI, kg/m² ‐ LCn3 ‐ subgroup by intervention type.
Analysis 2.29
Analysis 2.29
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 29 BMI, kg/m² ‐ LCn3 ‐ subgroup by duration.
Analysis 2.30
Analysis 2.30
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 30 BMI, kg/m² ‐ LCn3 ‐ subgroup by primary or secondary prevention.
Analysis 2.31
Analysis 2.31
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 31 BMI, kg/m² ‐ LCn3 ‐ subgroup by statin use.
Analysis 2.32
Analysis 2.32
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 32 Other measures of adiposity ‐ LCn3.
Analysis 2.33
Analysis 2.33
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 33 Total cholesterol, serum, mmoL/L ‐ LCn3.
Analysis 2.34
Analysis 2.34
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 34 TC, mmoL/L ‐ LCn3 ‐ SA by summary risk of bias.
Analysis 2.35
Analysis 2.35
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 35 TC, mmoL/L ‐ LCn3 ‐ SA by compliance and study size.
Analysis 2.36
Analysis 2.36
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 36 TC, mmoL/L ‐ LCn3 ‐ subgroup by dose.
Analysis 2.37
Analysis 2.37
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 37 TC, mmoL/L ‐ LCn3 ‐ subgroup by replacement.
Analysis 2.38
Analysis 2.38
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 38 TC, mmoL/L ‐ LCn3 ‐ subgroup by intervention type.
Analysis 2.39
Analysis 2.39
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 39 TC, mmoL/L ‐ LCn3 ‐ subgroup by duration.
Analysis 2.40
Analysis 2.40
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 40 TC, mmoL/L ‐ LCn3 ‐ subgroup by primary or secondary prevention.
Analysis 2.41
Analysis 2.41
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 41 TC, mmoL/L ‐ LCn3 ‐ subgroup by statin use.
Analysis 2.42
Analysis 2.42
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 42 Triglycerides, fasting, serum, mmoL/L ‐ LCn3.
Analysis 2.43
Analysis 2.43
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 43 TG, fasting, mmoL/L ‐ LCn3 ‐ SA by summary risk of bias.
Analysis 2.44
Analysis 2.44
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 44 TG, fasting, mmoL/L ‐ LCn3 ‐ SA by compliance and study size.
Analysis 2.45
Analysis 2.45
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 45 TG, fasting, mmoL/L ‐ LCn3 ‐ subgroup by dose.
Analysis 2.46
Analysis 2.46
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 46 TG, fasting, mmoL/L ‐ LCn3 ‐ subgroup by replacement.
Analysis 2.47
Analysis 2.47
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 47 TG, fasting, mmoL/L ‐ LCn3 ‐ subgroup by intervention type.
Analysis 2.48
Analysis 2.48
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 48 TG, fasting, mmoL/L ‐ LCn3 ‐ subgroup by duration.
Analysis 2.49
Analysis 2.49
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 49 TG, fasting, mmoL/L ‐ LCn3 ‐ subgroup by primary or secondary prevention.
Analysis 2.50
Analysis 2.50
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 50 TG, fasting, mmoL/L ‐ LCn3 ‐ subgroup by statin use.
Analysis 2.51
Analysis 2.51
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 51 High‐density lipoprotein, serum, mmoL/L ‐ LCn3.
Analysis 2.52
Analysis 2.52
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 52 HDL, mmoL/L ‐ LCn3 ‐ SA by summary risk of bias.
Analysis 2.53
Analysis 2.53
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 53 HDL, mmoL/L ‐ LCn3 ‐ SA by compliance and study size.
Analysis 2.54
Analysis 2.54
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 54 HDL, mmoL/L ‐ LCn3 ‐ subgroup by dose.
Analysis 2.55
Analysis 2.55
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 55 HDL, mmoL/L ‐ LCn3 ‐ subgroup by replacement.
Analysis 2.56
Analysis 2.56
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 56 HDL, mmoL/L ‐ LCn3 ‐ subgroup by intervention type.
Analysis 2.57
Analysis 2.57
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 57 HDL, mmoL/L ‐ LCn3 ‐ subgroup by duration.
Analysis 2.58
Analysis 2.58
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 58 HDL, mmoL/L ‐ LCn3 ‐ subgroup by primary or secondary prevention.
Analysis 2.59
Analysis 2.59
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 59 HDL, mmoL/L ‐ LCn3 ‐ subgroup by statin use.
Analysis 2.60
Analysis 2.60
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 60 Low‐density lipoprotein, serum, mmoL/L ‐ LCn3.
Analysis 2.61
Analysis 2.61
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 61 LDL, mmoL/L ‐ LCn3 ‐ SA by summary risk of bias.
Analysis 2.62
Analysis 2.62
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 62 LDL, mmoL/L ‐ LCn3 ‐ SA by compliance and study size.
Analysis 2.63
Analysis 2.63
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 63 LDL, mmoL/L ‐ LCn3 ‐ subgroup by dose.
Analysis 2.64
Analysis 2.64
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 64 LDL, mmoL/L ‐ LCn3 ‐ subgroup by replacement.
Analysis 2.65
Analysis 2.65
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 65 LDL, mmoL/L ‐ LCn3 ‐ subgroup by intervention type.
Analysis 2.66
Analysis 2.66
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 66 LDL, mmoL/L ‐ LCn3 ‐ subgroup by duration.
Analysis 2.67
Analysis 2.67
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 67 LDL, mmoL/L ‐ LCn3 ‐ subgroup by primary or secondary prevention.
Analysis 2.68
Analysis 2.68
Comparison 2 High vs low LCn3 omega‐3 fats (secondary outcomes), Outcome 68 LDL, mmoL/L ‐ LCn3 ‐ subgroup by statin use.
Analysis 3.1
Analysis 3.1
Comparison 3 High vs low LCn3 omega‐3 fats (tertiary outcomes), Outcome 1 Blood pressure, mmHg ‐ LCn3.
Analysis 3.2
Analysis 3.2
Comparison 3 High vs low LCn3 omega‐3 fats (tertiary outcomes), Outcome 2 Serious adverse events ‐ LCn3.
Analysis 3.3
Analysis 3.3
Comparison 3 High vs low LCn3 omega‐3 fats (tertiary outcomes), Outcome 3 Side effects ‐ LCn3.
Analysis 3.4
Analysis 3.4
Comparison 3 High vs low LCn3 omega‐3 fats (tertiary outcomes), Outcome 4 Dropouts ‐ LCn3.
Analysis 4.1
Analysis 4.1
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 1 All‐cause mortality (overall) ‐ ALA.
Analysis 4.2
Analysis 4.2
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 2 All‐cause mortality ‐ ALA ‐ sensitivity analysis (SA) fixed‐effect.
Analysis 4.3
Analysis 4.3
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 3 All‐cause mortality ‐ ALA ‐ SA by summary risk of bias.
Analysis 4.4
Analysis 4.4
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 4 All‐cause mortality ‐ ALA ‐ SA by compliance and study size.
Analysis 4.5
Analysis 4.5
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 5 All‐cause mortality ‐ ALA ‐ subgroup by dose.
Analysis 4.6
Analysis 4.6
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 6 All‐cause mortality ‐ ALA ‐ subgroup by replacement.
Analysis 4.7
Analysis 4.7
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 7 All cause mortality ‐ ALA ‐ subgroup by intervention type.
Analysis 4.8
Analysis 4.8
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 8 All‐cause mortality ‐ ALA ‐ subgroup by duration.
Analysis 4.9
Analysis 4.9
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 9 All‐cause mortality ‐ ALA ‐ subgroup by primary or secondary prevention.
Analysis 4.10
Analysis 4.10
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 10 All‐cause mortality ‐ ALA ‐ subgroup by statin use.
Analysis 4.11
Analysis 4.11
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 11 Cardiovascular mortality (overall) ‐ ALA.
Analysis 4.12
Analysis 4.12
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 12 CVD mortality ‐ ALA ‐ SA fixed‐effect.
Analysis 4.13
Analysis 4.13
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 13 CVD mortality ‐ ALA ‐ SA by summary risk of bias.
Analysis 4.14
Analysis 4.14
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 14 CVD mortality ‐ ALA ‐ SA by compliance and study size.
Analysis 4.15
Analysis 4.15
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 15 CVD mortality ‐ ALA ‐ subgroup by dose.
Analysis 4.16
Analysis 4.16
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 16 CVD mortality ‐ ALA ‐ subgroup by replacement.
Analysis 4.17
Analysis 4.17
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 17 CVD mortality ‐ ALA ‐ subgroup by intervention type.
Analysis 4.18
Analysis 4.18
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 18 CVD mortality ‐ ALA ‐ subgroup by duration.
Analysis 4.19
Analysis 4.19
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 19 CVD mortality ‐ ALA ‐ subgroup by primary or secondary prevention.
Analysis 4.20
Analysis 4.20
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 20 CVD mortality ‐ ALA ‐ subgroup by statin uses.
Analysis 4.21
Analysis 4.21
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 21 Cardiovascular events (overall) ‐ ALA.
Analysis 4.22
Analysis 4.22
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 22 CVD events ‐ ALA ‐ SA fixed‐effect.
Analysis 4.23
Analysis 4.23
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 23 CVD events ‐ ALA ‐ SA by summary risk of bias.
Analysis 4.24
Analysis 4.24
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 24 CVD events ‐ ALA ‐ SA by compliance and study size.
Analysis 4.25
Analysis 4.25
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 25 CVD events ‐ ALA ‐ subgroup by dose.
Analysis 4.26
Analysis 4.26
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 26 CVD events ‐ ALA ‐ subgroup by replacement.
Analysis 4.27
Analysis 4.27
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 27 CVD events ‐ ALA ‐ subgroup by intervention type.
Analysis 4.28
Analysis 4.28
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 28 CVD events ‐ ALA ‐ subgroup by duration.
Analysis 4.29
Analysis 4.29
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 29 CVD events ‐ ALA ‐ subgroup by primary or secondary prevention.
Analysis 4.30
Analysis 4.30
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 30 CVD events ‐ ALA ‐ subgroup by statin use.
Analysis 4.31
Analysis 4.31
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 31 Coronary heart disease mortality (overall) ‐ ALA.
Analysis 4.32
Analysis 4.32
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 32 CHD mortality ‐ ALA ‐ SA fixed‐effect.
Analysis 4.33
Analysis 4.33
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 33 CHD mortality ‐ ALA ‐ SA by summary risk of bias.
Analysis 4.34
Analysis 4.34
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 34 CHD mortality ‐ ALA ‐ SA by compliance and study size.
Analysis 4.35
Analysis 4.35
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 35 CHD mortality ‐ ALA ‐ subgroup by dose.
Analysis 4.36
Analysis 4.36
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 36 CHD mortality ‐ ALA ‐ subgroup by replacement.
Analysis 4.37
Analysis 4.37
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 37 CHD mortality ‐ ALA ‐ subgroup by intervention type.
Analysis 4.38
Analysis 4.38
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 38 CHD mortality ‐ ALA ‐ subgroup by duration.
Analysis 4.39
Analysis 4.39
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 39 CHD mortality ‐ ALA ‐ subgroup by primary or secondary prevention.
Analysis 4.40
Analysis 4.40
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 40 CHD mortality ‐ ALA ‐ subgroup by statin use.
Analysis 4.41
Analysis 4.41
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 41 CHD mortality ‐ ALA ‐ subgroup by CAD history.
Analysis 4.42
Analysis 4.42
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 42 Coronary heart disease events (overall) ‐ ALA.
Analysis 4.43
Analysis 4.43
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 43 CHD events ‐ ALA ‐ SA fixed‐effect.
Analysis 4.44
Analysis 4.44
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 44 CHD events ‐ ALA ‐ SA by summary risk of bias.
Analysis 4.45
Analysis 4.45
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 45 CHD events ‐ ALA ‐ SA by compliance and study size.
Analysis 4.46
Analysis 4.46
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 46 CHD events ‐ ALA ‐ subgroup by dose.
Analysis 4.47
Analysis 4.47
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 47 CHD events ‐ ALA ‐ subgroup by replacement.
Analysis 4.48
Analysis 4.48
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 48 CHD events ‐ ALA ‐ subgroup by intervention type.
Analysis 4.49
Analysis 4.49
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 49 CHD events ‐ ALA ‐ subgroup by duration.
Analysis 4.50
Analysis 4.50
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 50 CHD events ‐ ALA ‐ subgroup by primary or secondary prevention.
Analysis 4.51
Analysis 4.51
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 51 CHD events ‐ ALA ‐ subgroup by statin use.
Analysis 4.52
Analysis 4.52
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 52 CHD events ‐ ALA ‐ subgroup by CAD history.
Analysis 4.53
Analysis 4.53
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 53 Stroke (overall) ‐ ALA.
Analysis 4.54
Analysis 4.54
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 54 Stroke ‐ ALA ‐ SA fixed‐effect.
Analysis 4.55
Analysis 4.55
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 55 Stroke ‐ ALA ‐ SA by summary risk of bias.
Analysis 4.56
Analysis 4.56
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 56 Stroke ‐ ALA ‐ SA by compliance and study size.
Analysis 4.57
Analysis 4.57
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 57 Stroke ‐ ALA ‐ subgroup by dose.
Analysis 4.58
Analysis 4.58
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 58 Stroke ‐ ALA ‐ subgroup by replacement.
Analysis 4.59
Analysis 4.59
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 59 Stroke ‐ ALA ‐ subgroup by intervention type.
Analysis 4.60
Analysis 4.60
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 60 Stroke ‐ ALA ‐ subgroup by duration.
Analysis 4.61
Analysis 4.61
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 61 Stroke ‐ ALA ‐ subgroup by primary or secondary prevention.
Analysis 4.62
Analysis 4.62
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 62 Stroke ‐ ALA ‐ subgroup by statin use.
Analysis 4.63
Analysis 4.63
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 63 Stroke ‐ ALA ‐ subgroup by stroke type.
Analysis 4.64
Analysis 4.64
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 64 Arrythmia (overall) ‐ ALA.
Analysis 4.65
Analysis 4.65
Comparison 4 High vs low ALA omega‐3 fat (primary outcomes), Outcome 65 Arrhythmia ‐ ALA ‐ SA by summary risk of bias.
Analysis 5.1
Analysis 5.1
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 1 MACCEs ‐ ALA.
Analysis 5.2
Analysis 5.2
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 2 Myocardial infarction (overall) ‐ ALA.
Analysis 5.3
Analysis 5.3
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 3 Total MI ‐ ALA ‐ subgroup by fatality.
Analysis 5.4
Analysis 5.4
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 4 Angina ‐ ALA.
Analysis 5.5
Analysis 5.5
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 5 Revascularisation ‐ ALA.
Analysis 5.6
Analysis 5.6
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 6 Peripheral arterial disease ‐ ALA.
Analysis 5.7
Analysis 5.7
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 7 Body weight, kg ‐ ALA.
Analysis 5.8
Analysis 5.8
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 8 Weight, kg ‐ ALA ‐ sensitivity analysis (SA) fixed‐effect.
Analysis 5.9
Analysis 5.9
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 9 Weight, kg ‐ ALA ‐ SA by summary risk of bias.
Analysis 5.10
Analysis 5.10
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 10 Weight, kg ‐ ALA ‐ SA by compliance and study size.
Analysis 5.11
Analysis 5.11
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 11 Weight, kg ‐ ALA ‐ subgroup by dose.
Analysis 5.12
Analysis 5.12
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 12 Weight, kg ‐ ALA ‐ subgroup by intervention type.
Analysis 5.13
Analysis 5.13
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 13 Weight, kg ‐ ALA ‐ subgroup by replacement.
Analysis 5.14
Analysis 5.14
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 14 Weight, kg ‐ ALA ‐ subgroup by duration.
Analysis 5.15
Analysis 5.15
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 15 Weight, kg ‐ ALA ‐ subgroup by statin use.
Analysis 5.16
Analysis 5.16
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 16 Weight, kg ‐ ALA ‐ subgroup by primary or secondary prevention.
Analysis 5.17
Analysis 5.17
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 17 Body mass index, kg/m² ‐ ALA.
Analysis 5.18
Analysis 5.18
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 18 BMI, kg/m² ‐ ALA ‐ SA fixed‐effect.
Analysis 5.19
Analysis 5.19
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 19 BMI, kg/m² ‐ ALA ‐ SA by summary risk of bias.
Analysis 5.20
Analysis 5.20
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 20 BMI, kg/m² ‐ ALA ‐ SA by compliance and study size.
Analysis 5.21
Analysis 5.21
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 21 BMI, kg/m² ‐ ALA ‐ subgroup by dose.
Analysis 5.22
Analysis 5.22
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 22 BMI, kg/m² ‐ ALA ‐ subgroup by intervention type.
Analysis 5.23
Analysis 5.23
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 23 BMI, kg/m² ‐ ALA ‐ subgroup by replacement.
Analysis 5.24
Analysis 5.24
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 24 BMI, kg/m² ‐ ALA ‐ subgroup by duration.
Analysis 5.25
Analysis 5.25
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 25 BMI, kg/m² ‐ ALA ‐ subgroup by statin use.
Analysis 5.26
Analysis 5.26
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 26 BMI, kg/m² ‐ ALA ‐ subgroup by primary or secondary preventionA.
Analysis 5.27
Analysis 5.27
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 27 Other measures of adiposity ‐ ALA.
Analysis 5.28
Analysis 5.28
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 28 Total cholesterol, serum, mmoL/L ‐ ALA.
Analysis 5.29
Analysis 5.29
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 29 TC, mmoL/L ‐ ALA ‐ SA fixed‐effect.
Analysis 5.30
Analysis 5.30
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 30 TC, mmoL/L ‐ ALA ‐ SA by summary risk of bias.
Analysis 5.31
Analysis 5.31
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 31 TC, mmoL/L ‐ ALA ‐ SA by compliance and study size.
Analysis 5.32
Analysis 5.32
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 32 TC, mmoL/L ‐ ALA ‐ subgroup by dose.
Analysis 5.33
Analysis 5.33
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 33 TC, mmoL/L ‐ ALA ‐ subgroup by intervention type.
Analysis 5.34
Analysis 5.34
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 34 TC, mmoL/L ‐ ALA ‐ subgroup by replacement.
Analysis 5.35
Analysis 5.35
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 35 TC, mmoL/L ‐ ALA ‐ subgroup by duration.
Analysis 5.36
Analysis 5.36
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 36 TC, mmoL/L ‐ ALA ‐ subgroup by statin use.
Analysis 5.37
Analysis 5.37
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 37 TC, mmoL/L ‐ ALA ‐ subgroup by primary or secondary preventionA.
Analysis 5.38
Analysis 5.38
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 38 Triglycerides, fasting, serum, mmoL/L ‐ ALA.
Analysis 5.39
Analysis 5.39
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 39 TG, fasting, mmoL/L ‐ ALA ‐ SA fixed‐effect.
Analysis 5.40
Analysis 5.40
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 40 TG, fasting, mmoL/L‐ ALA ‐ SA by summary risk of bias.
Analysis 5.41
Analysis 5.41
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 41 TG, fasting, mmoL/L‐ ALA ‐ SA by compliance and study size.
Analysis 5.42
Analysis 5.42
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 42 TG, fasting, mmoL/L ‐ ALA ‐ subgroup by dose.
Analysis 5.43
Analysis 5.43
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 43 TG, fasting, mmoL/L‐ ALA ‐ subgroup by intervention type.
Analysis 5.44
Analysis 5.44
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 44 TG, fasting, mmoL/L‐AL ‐ subgroup by replacementA.
Analysis 5.45
Analysis 5.45
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 45 TG, fasting, mmoL/L‐ ALA ‐ subgroup by duration.
Analysis 5.46
Analysis 5.46
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 46 TG, fasting, mmoL/L ‐ ALA ‐ subgroup by statin use.
Analysis 5.47
Analysis 5.47
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 47 TG, fasting, mmoL/L‐ ALA ‐ subgroup by primary or secondary prevention.
Analysis 5.48
Analysis 5.48
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 48 High‐density lipoprotein, serum, mmoL/L ‐ ALA.
Analysis 5.49
Analysis 5.49
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 49 HDL, mmoL/L ‐ ALA ‐ SA fixed‐effect.
Analysis 5.50
Analysis 5.50
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 50 HDL, mmoL/L ‐ ALA ‐ SA by summary risk of bias.
Analysis 5.51
Analysis 5.51
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 51 HDL, mmoL/L ‐ ALA ‐ SA by compliance and study size.
Analysis 5.52
Analysis 5.52
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 52 HDL, mmoL/L ‐ ALA ‐ subgroup by dose.
Analysis 5.53
Analysis 5.53
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 53 HDL, mmoL/L ‐ ALA ‐ subgroup by intervention type.
Analysis 5.54
Analysis 5.54
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 54 HDL, mmoL/L ‐ ALA ‐ subgroup by replacement.
Analysis 5.55
Analysis 5.55
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 55 HDL, mmoL/L ‐ ALA ‐ subgroup by duration.
Analysis 5.56
Analysis 5.56
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 56 HDL, mmoL/L ‐ ALA ‐ subgroup by statin use.
Analysis 5.57
Analysis 5.57
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 57 HDL, mmoL/L ‐ ALA ‐ subgroup by primary or secondary prevention.
Analysis 5.58
Analysis 5.58
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 58 Low‐density lipoprotein, serum, mmoL/L ‐ ALA.
Analysis 5.59
Analysis 5.59
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 59 LDL, mmoL/L ‐ ALA ‐ SA fixed‐effect.
Analysis 5.60
Analysis 5.60
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 60 LDL, mmoL/L ‐ ALA ‐ SA by summary risk of bias.
Analysis 5.61
Analysis 5.61
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 61 LDL, mmoL/L ‐ ALA ‐ SA by compliance and study size.
Analysis 5.62
Analysis 5.62
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 62 LDL, mmoL/L ‐ ALA ‐ subgroup by dose.
Analysis 5.63
Analysis 5.63
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 63 LDL, mmoL/L ‐ ALA ‐ subgroup by intervention type.
Analysis 5.64
Analysis 5.64
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 64 LDL, mmoL/L ‐ ALA ‐ subgroup by replacement.
Analysis 5.65
Analysis 5.65
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 65 LDL, mmoL/L ‐ ALA ‐ subgroup by duration.
Analysis 5.66
Analysis 5.66
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 66 LDL, mmoL/L ‐ ALA ‐ subgroup by statin use.
Analysis 5.67
Analysis 5.67
Comparison 5 High vs low ALA omega‐3 fat (secondary outcomes), Outcome 67 LDL, mmoL/L ‐ ALA ‐ subgroup by primary or secondary prevention.
Analysis 6.1
Analysis 6.1
Comparison 6 High vs low ALA omega‐3 fats (tertiary outcomes), Outcome 1 Blood pressure, mmHg ‐ ALA.
Analysis 6.2
Analysis 6.2
Comparison 6 High vs low ALA omega‐3 fats (tertiary outcomes), Outcome 2 Serious adverse events ‐ ALA.
Analysis 6.3
Analysis 6.3
Comparison 6 High vs low ALA omega‐3 fats (tertiary outcomes), Outcome 3 Side effects ‐ ALA.
Analysis 6.4
Analysis 6.4
Comparison 6 High vs low ALA omega‐3 fats (tertiary outcomes), Outcome 4 Dropouts ‐ ALA.

Update of

  • Omega 3 fatty acids for prevention and treatment of cardiovascular disease.
    Hooper L, Thompson RL, Harrison RA, Summerbell CD, Moore H, Worthington HV, Durrington PN, Ness AR, Capps NE, Davey Smith G, Riemersma RA, Ebrahim SB. Hooper L, et al. Cochrane Database Syst Rev. 2004 Oct 18;(4):CD003177. doi: 10.1002/14651858.CD003177.pub2. Cochrane Database Syst Rev. 2004. PMID: 15495044 Free PMC article. Updated. Review.

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