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Fish oils do not prevent heart attack or strokes with diabetes

Randomised controlled trial did not find that fish oil supplements protected against cardiovascular events

Ingrid Torjesen

Tuesday, 28 August 2018

Fish oil supplements do not prevent heart attacks or strokes in patients with diabetes, according to results* from the ASCEND trial at ESC Congress 2018 and published in the New England Journal of Medicine.

In observational studies, higher consumption of fish is associated with lower risks of coronary artery disease and stroke. However, previous randomised trials have not been able to show that taking fish oil supplements containing omega-3 fatty acids reduces the risk of having cardiovascular events.

The ASCEND trial (A Study of Cardiovascular Events in Diabetes) examined whether fish oil supplements reduce the risk of a cardiovascular event specifically in patients with diabetes. Between 2005 and 2011, 15,480 patients with diabetes but no history of cardiovascular disease were randomly assigned to fish oil supplementation (1 g daily) or placebo.

The primary efficacy outcome was first serious vascular event, which included non-fatal heart attacks, non-fatal strokes or transient ischaemic attacks, or deaths from a cardiovascular cause (but excluding any intracranial haemorrhage).

During an average of 7.4 years of follow-up, a first serious vascular event occurred in 689 (8.9%) participants allocated fish oil supplements and 712 (9.2%) participants allocated placebo. There was no significant difference between the two groups: rate ratio of 0.97 (95% confidence interval 0.87-1.08, p=0.55).

Dr Louise Bowman, principal investigator, Nuffield Department of Population Health, University of Oxford, UK, said: "Our large, long-term randomised trial shows that fish oil supplements do not reduce the risk of cardiovascular events in patients with diabetes. This is a disappointing finding, but it is in line with previous randomised trials in other types of patient at increased risk of cardiovascular events which also showed no benefit of fish oil supplements. There is no justification for recommending fish oil supplements to protect against cardiovascular events."


*The ASCEND Study Collaborative Group. Effects of n−3 Fatty Acid Supplements in Diabetes Mellitus. NJEM, August 26, 2018, DOI: 10.1056/NEJMoa1804989

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