High-Dose Omega-3 Fatty Acids Reduced Adverse Events After MI

Among patients with acute myocardial infarction (MI), high doses of omega-3 fatty acids were associated with a reduction of adverse left ventricular remodeling, noninfarct myocardial fibrosis, and serum biomarkers of systemic inflammation, according to results from the OMEGA-REMODEL (Omega-3 Acid Ethyl Esters on Left Ventricular Remodeling After Acute Myocardial Infarction) study.

The OMEGA-REMODEL study is a multicenter, double-blind, placebo-controlled trial that included 358 participants presenting with an acute MI. The findings were published in Circulation.

Raymond Y. Kwong, MD, MPH, director of Cardiac Magnetic Resonance Imaging at Brigham and Women’s Hospital in Boston, MA, and colleagues randomly assigned 180 patients to receive 6 months of high-dose omega-3 fatty acids and 178 patients to a placebo group.

Researchers used cardiac magnetic resonance imaging to assess cardiac structure and tissue characteristics at baseline and after study therapy. They measured change in left ventricular systolic volume index as the primary end point. Change in noninfarct myocardial fibrosis, left ventricular ejection fraction, and infarct size were secondary end points.

“In comparison with placebo, patients who received 4 g of O-3FA [omega-3 fatty acids] daily experienced significant improvement in both left ventricular end-systolic volume and a surrogate cardiac MRI measure of noninfarct myocardial fibrosis during the first 6 months of infarct healing,” the authors wrote. “These remodeling benefits followed a dose response relationship with the rise of the in vivo O-3FA levels quantified by the red blood cell index.”

Patients who received omega-3 fatty acids showed significant reduction of left ventricular systolic volume index (–5.8%, P=.017) and noninfarct myocardial fibrosis (–5.6%, P=.026) compared with the placebo group.

The patients who achieved the highest quartile increase in red blood cell omega-3 index reduced left ventricular systolic volume index by 13% compared with patients with the lowest quartile. Those who received omega-3 fatty acids also experienced significant reductions in serum biomarkers, vascular inflammation, and myocardial fibrosis. Adverse events were not associated with high-dose omega-3 fatty acid therapy.

“The OMEGA-REMODEL study provides randomized trial evidence that 4 g daily dose of O-3FA is a safe and effective treatment in improving cardiac remodeling in patients receiving current guideline-based post–myocardial infarction therapies,” the authors concluded.

“Given that the incidence of heart failure after acute myocardial infarction remains high despite current therapies, the cardiac remodeling benefits from O-3FA may translate to a significant clinical impact and warrants prospective clinical studies.”

They noted that further studies should be conducted to determine the effect of earlier omega-3 fatty acid therapy on improving cardiac remodeling, myocardial tissue characteristics, and clinical outcomes.

Reference

Heydari B, Abdullah S, Pottala JV, et al. Effect of omega-3 acid ethyl esters on left ventricular remodeling after acute myocardial infarction: the OMEGA-REMODEL randomized clinical trial. Circulation. 2016. doi: 10.1161/circulationAHA.115.019949.