What is the place of
fish oils in the care of
coronary heart disease (CHD) patients? As several clinical trials have already addressed this question without giving definitive answers, we did a meta-analysis of trials regarding the efficacy of
omega-3 fatty acids in preventing cardiovascular mortality and morbidity. We searched the MEDLINE (1966-2003), EMBASE databases, proceedings abstracts and references of reviewed articles. Randomized controlled trials (RCTs) of the efficacy of
omega-3 fatty acids among adults with recent or acute
myocardial infarction (MI), or angina were selected. Two reviewers abstracted data independently. Five relevant outcomes, mortality from all causes, fatal and non-fatal MI, non-fatal
stroke and angina, were measured. Data were synthesized using a fixed effect model. Ten RCTs with 14,727 patients were included. No significant heterogeneity was detected. Daily intake of
omega-3 fatty acids for a mean duration of 37 months decreased all causes of mortality by 16% (relative risk 0.84, 95% confidence interval [0.76; 0.94]) and the incidence of death due to MI by 24% (0.76, [0.66; 0.88]). No significant effect was found for the other outcomes. Because of the suboptimal quality of the studies included into the meta-analysis and the absence of data in patients receiving
statins, these results do not justify adding
fish oils systematically to the heavy
pharmaceutical assortment already recommended in CHD patients.