Nutritional Research Series: Volume 4: Effects of Eicosapentanoic Acid and Docosahexanoic Acid on Mortality Across Diverse Settings: Systematic Review and Meta-Analysis of Randomized Trials and Prospective Cohorts. Technical Review 17

摘要

Eicosapentanoic acid (EPA) and docosahexanoic acid (DHA) intake may protect from cardiovascular or all-cause mortality. The objective is to synthesize evidence from randomized controlled trials (RCTs) and large prospective cohorts on the effects of EPA and DHA on cardiac, cardiovascular, or all-cause mortality. We conducted a systematic review with random effects meta-analysis and mixed effects dose-response meta-regression. Included were RCTs of EPA and DHA supplementation (>4 weeks of intervention, 1000 people, >3 years of followup) quantifying DHA or EPA intake. In RCTs, the summary relative risks for all-cause mortality (17 trials, 51,264 patients) and cardiovascular mortality (14 trials, 48,500 patients) were 0.95 (95% confidence interval, CI: 0.89, 1.01) and 0.89 (95% CI, 0.83, 0.96), respectively, with no evidence for heterogeneity. The effect of DHA and EPA was not significantly associated with population or study characteristics or supplement dose. In dose-response meta-regressions, mean EPA and DHA intake up to 0.20 grams daily was associated with decreased risk of cardiac, cardiovascular, or sudden cardiac death (odds ratio 0.64 per 0.20 grams average daily intake, 95% CI: 0.46, 0.89--data from 7 cohorts, 123,122 participants), with no significant change in risk (positive or negative) at higher mean intakes.