Post-stroke therapy: with omega-3s fewer deaths and recurrences

In acute myocardial infarction survivors, omega-3 treatment is found to be associated with a 24% reduction in mortality and 35% reduction in recurrence. A finding that supports the results of other recent clinical trials, helping to clarify the protective role of EPA and DHA therapy in the post-infarction period.

This is shown by a large study conducted in Italy by researchers at the University of Brescia and published in the American Journal of Cardiology.

Need for "Real World" studies

The results obtained confirm those of a major Italian study, GISSI-Prevenzione, which had shown in 1999, that in heart attack survivors, treatment with 1 gram per day of omega-3 reduced the risk of death, recurrence, and stroke. Although other research has also highlighted its beneficial role, there is still skepticism about omega-3 therapy in the period following heart attack, both because of insufficient data on this type of treatment and the conflicting results of some studies. As explained by the Brescia University authors themselves, the heterogeneity of the observed effects is probably due to some limitations of the randomized clinical trials (RTCs) conducted so far. 

RTC studies, in fact, include selected populations of subjects, with the exclusion of those with other diseases or special health conditions, and are conducted for a time-limited period of treatment and observation. What emerges from RCTs, therefore, is not always generalizable to the real clinic where, among other things, adherence to treatments established by guidelines is generally poorer. In the case of research regarding omega-3 supplementation, the doses used were often very low compared with some recent work, such as the OMEGA-REMODEL in which administration of 4 grams of omega-3 within 1 month after infarction promoted left ventricular remodeling and reduced inflammation. 

For these reasons, the need for a "Real World" study, which considers data from the medical records of real patients with their own medical histories, arose for the Italian researchers, allowing information on a large number of subjects and over very long periods of time.

Relationship found between omega-3 and reduced likelihood of new heart attack 

Reassessment of the role of omega-3s in recently discharged post-infarction patients in the Real World took into account the characteristics of the subjects and any concomitant therapies. Results showed that omega-3 treatment was strongly associated with a 35% reduction in the risk of new heart attack and also of death from all causes by 24%. 

These data were observed despite the fact that about half of the omega-3-treated subjects did not fully comply with the therapy, showing a maximum adherence of 80 percent. Furthermore, the study found that the beneficial effects of omega-3 on heart attack recurrence were evident only in patients who had taken statins, of the common cholesterol control drugs, suggesting the interaction between specific therapies and omega-3.

Study details

The study was the first conducted in Italy with real clinical data on a large number of heart attack survivors. In order to carry it out, the researchers used the administrative databases of 5 Local Health Units (LHUs). Those who had been discharged from the hospital with a principal diagnosis of acute myocardial infarction between January 2010 and December 2011 were included in the research. Information on hospital discharge, medications prescribed, and mortality, if any, was identified for each subject. Participants were then followed for 12 months after discharge. A total of 11,269 patients, with a mean age of 69 years, were included in the study, among whom 2,425 had taken omega-3. Patients' characteristics, and risk of mortality and new heart attack, were related to daily prescription of 1 gram of omega-3, after discharge. Subjects treated with the fatty acids tended to be younger, male, and had diabetes. Compared with the others they showed greater likelihood of following the post-infarction medical therapy reported in the guidelines, which included several drugs including beta-blockers, statins, and antiplatelets.

Omega-3s as supportive therapy

According to the study authors, this research shows a strong independent association of omega-3 treatment with reduced mortality and recurrence, in heart attack survivors. This, as the researchers pointed out, does not suggest any change in the medical therapies recommended to date, but supports the hypothesis that omega-3s can enhance the effect of statins, improving patient's lives and reducing re-hospitalizations. 

 Source: Greene SJ, Temporelli PL, Campia U, et al. Effects of Polyunsaturated Fatty Acid Treatment on Postdischarge Outcomes After Acute Myocardial Infarction. Am J Cardiol, 2015 Nov 18.