n-3 Fatty Acids, Ventricular Arrhythmia–Related Events, and Fatal Myocardial Infarction in Postmyocardial Infarction Patients With Diabetes

Division of Human Nutrition, Wageningen University, Wageningen, the Netherlands.
Diabetes care (Impact Factor: 8.42). 12/2011; 34(12):2515-20. DOI: 10.2337/dc11-0896
Source: PubMed


We carried out a secondary analysis in high-risk patients with a previous myocardial infarction (MI) and diabetes in the Alpha Omega Trial. We tested the hypothesis that in these patients an increased intake of the n-3 fatty acids eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), and α-linolenic acid (ALA) will reduce the incidence of ventricular arrhythmias and fatal MI.
A subgroup of 1,014 post-MI patients with diabetes aged 60-80 years was randomly allocated to receive one of four trial margarines, three with an additional amount of n-3 fatty acids and one placebo for 40 months. The end points were ventricular arrhythmia-related events and fatal MI. The data were analyzed according to the intention-to-treat principle, using multivariable Cox proportional hazards models.
The patients consumed on average 18.6 g of margarine per day, which resulted in an additional intake of 223 mg EPA plus 149 mg DHA and/or 1.9 g ALA in the active treatment groups. During follow-up, 29 patients developed a ventricular arrhythmia-related events and 27 had a fatal MI. Compared with placebo patients, the EPA-DHA plus ALA group experienced less ventricular arrhythmia-related events (hazard ratio 0.16; 95% CI 0.04-0.69). These n-3 fatty acids also reduced the combined end-point ventricular arrhythmia-related events and fatal MI (0.28; 0.11-0.71).
Our results suggest that low-dose supplementation of n-3 fatty acids exerts a protective effect against ventricular arrhythmia-related events in post-MI patients with diabetes.

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    • "In meta-analyses, fish oil supplementation has been shown to be associated with no increase( 13 ) or a non-significant increase( 14 , 15 ) in fasting blood glucose and HbA1c. Data on the association between long-chain n-3 fatty acids and mortality in patients with diabetes are limited( 16 – 18 ). The association between the relative concentrations of individual plasma phospholipid long-chain n-3 and n-6 fatty acids and total mortality in patients with type 2 diabetes is unknown. "
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    11/2013; 2. DOI:10.1017/jns.2013.30
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    • "gnificantly were reduced in the ALA - group ( HR 0 . 39 ; 95% CI 0 . 17 - 0 . 88 ) . In a secondary analysis of the Alpha - Omega Trial taking high risk patients with previous myocardial infarction and diabetes the EPA - DHA plus ALA group experienced significantly less ventricular arrhythmia - related events ( HR 0 . 16 ; 95% CI 0 . 04 - 0 . 69 ; Kromhout D et al . 2011 ) . These differential results again underscore the necessity to exactly define the clinical conditions under which supplementation of Ω - 3 may be beneficial . The OMEGA trial tested the effect of supplementation with 1 g / day of esterified EPA / DHA on the rate of SCD and other clinical events within one year after acute myocardial i"
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    The Journal of Clinical Psychiatry 11/2013; 74(11):e1037-e1045. DOI:10.4088/JCP.13m08453 · 5.50 Impact Factor
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    • "Similar to our previous investigation [20], a study among post-AMI patients did not report any overall relations between n-3 LCPUFAs and cardiovascular events [31]. However, in accordance with our current results, a post hoc analysis among participants with diabetes revealed a strong decline in ventricular arrhythmia-related events and fatal AMI with increased n-3 LCPUFA intake [32]. Other studies have also indicated that a high intake may reduce the risk of non-fatal AMI [33-36]. "
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