The Effectiveness of Omega-3 Polyunsaturated Fatty Acid Supplementation in Preventing Sudden Cardiac Death and Fatal Arrhythmias among Adult Coronary Artery Disease Patients: A Meta- analysis

BACKGROUND: Almost 90% of patients develop fatal arrhythmias after acute myocardial infarction. For three decades, studies recommended omega-3 polyunsaturated fatty acid (PUFA) intake in preventing sudden death and lethal arrhythmias in coronary artery disease (CAD). However, recent equivocal and contrasting data question the benefits of omega-3 PUFA. OBJECTIVES: To evaluate the benefit of omega-3 PUFA in preventing sudden cardiac death (SCD) and fatal arrhythmias among CAD patients. METHODS: This was a systematic review and meta-analysis of randomized controlled trials comparing the benefits of omega-3 PUFA vs control in preventing SCD and fatal arrhythmias. The primary outcomes were SCD and occurrence of fatal arrhythmias. Secondary outcomes included all-cause mortality; cardiovascular (CV) death, and occurrence of major adverse cerebrovascular and cardiovascular events (MACCE). RESULTS: Eleven RCTs were included in the meta-analysis. The effect of omega-3 PUFAs on SCD was not significant (RR 0.95, [0.84, 1.08]; p=0.40; I2=0.40). Pooled analysis of five RCTs reporting the effect on fatal arrhythmias was also not significant (RR 0.98, [0.60, 1.61]; p=0.94; I2=0.68). Pooled analysis of the effect on CV death rate favored omega-3 PUFA use (RR 0.91, [0.83, 0.99]; p=0.02; I2=0.21). The effects on all-cause mortality (RR 0.95, [0.84, 1.08]; p=0.42; I2=0.47) and MACCE (RR 1.02, [0.88, 1.18]; p=0.81; I2=0.90) were not significant. CONCLUSIONS: Omega-3 PUFA oral supplementation showed no benefit in preventing SCD and fatal arrhythmias in CAD. Furthermore, no favorable effects on all-cause mortality and occurrence of MACCE were noted. However, omega-3 PUFAs did PREVENT CV death among CAD patients.