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Independents' Day

Earlier use of omega-3s after a heart attack cuts mortality, claim researchers

Prescribing omega-3 supplements within two weeks of a heart attack reduces the risk of death by almost a third, claim UK researchers.

Their study showed that very early administration of omega-3 fatty acid supplements was more effective at preventing a mortality than following NICE advice to prescribe them within three months.

They looked at 2,466 UK patients who were prescribed a 1g daily dose of omega-3 fatty acids for secondary prevention of an MI, and compared each case with four controls who had a MI but were not prescribed the supplements.

The prescription of omega-3 supplements within 90 days of a myocardial infarction (MI) significantly reduced the risk of mortality by 21%, compared with those patients not taking omega-3 supplements.

This mortality reduction increased to 32% if prescribed within 14 days, compared with those not taking omega-3 supplements.

NICE currently recommend that patients who have had an MI within three months should be offered a prescription for at least a 1g daily omega-3 supplement, licensed for secondary prevention post-MI.

Study lead Professor Craig Currie, professor of applied pharmacoepidemiology at Cardiff University, said: ‘Although we did not examine for dose effects, the timing of administration of n-3 fatty acid treatment seems relevant for optimising survival benefit in secondary prevention patients post-MI.

‘Very early administration after hospital admission of higher doses of the licensed n-3 fatty acids should be evaluated.’

The recent ORIGIN trial found no difference between patients taking omega-3 supplements and those taking a placebo in over 12,000 patients with high cardiovascular risk, but this trial did not look at the time of initiation.

Dr Kosta Manis, a GP in Bexley and cardiology lead for the Bexley Clinical Commissioning Group, thought socioeconomic differences might explain the results.

He said: ‘In their own summary, they recognise that there are socioeconomic differences within the groups. I wonder if the results would have been the same had the groups been balanced for socioeconomic parameters.’

Despite this, Dr Manis did advocate the use of omega-3 in post-MI patients.

‘If I had an MI, I would have taken omega-3, particularly if I did not like eating oily fish twice a week.’

Dr Rubin Minhas, clinical director of the BMJ Clinical Evidence Centre and a GP in Hoo, Kent, said: ‘GPs should consider the NICE guidelines and the prescription of omega-3 acids in post-MI patients.

‘This research should stimulate trials in other groups, such as diabetics, to establish benefit of early initiation.’


Reduction in mortality risk with omega-3

Initiation time                           Reduction in mortality risk

Within 90 days                                   21%

Within 14 days                                   32%

Source: Clinical Therapeutics, online 17 December


Readers' comments (2)

  • If the evidence is so robust, why do the prescribing teams not llike omega -3 -- Cost?

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  • The evidence is not robust. The Current NICE recommendation is based on the GISSI-P and JELIS studies. These had major limitations though, the most significant of which is the fact that statin therapy was either changing or not optimized in the sample population. In addition these studies were not placebo controlled.
    A recent meta-analysis by Kwak et al considered omega-3 fatty acids for secondary prevention of CV disease. The study included 14 double-blind placebo-controlled RCT's of omega-3 fatty acid esters in patients with a history of CV disease. This analysis found no statistically significant reduction in risk.

    NICE only recommends a limited role of the licensed preparations of omega-3 fatty acid esters post MI in so far it states that prescribers should consider prescribing these supplements within 3 months post-MI if patients are not acheiving 7g of fatty acid esters from 2 to 4 portions of oily fish per week. That is quite different from interpreting NICE guidelines as "patients should be offered a prescription", as indicated in the main article.

    So cost is not the main issue. It is the cost associated with an unproven treatment recommended by pharmaceutical companies, being very selective in what they highlight and promote to prescribers. NICE also states that if prescribed, it should only be prescribed for up to 4 years. How many prescribers have stopped prescribing this after 4 years?

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