Omega-3 reduced cardiovascular deaths by 16 percent (427,678 people) – March 2020

Associations of habitual fish oil supplementation with cardiovascular outcomes and all cause mortality: evidence from a large population based cohort study

BMJ 2020; 368 doi: https://doi.org/10.1136/bmj.m456

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Zhi-Hao Li, doctoral student1, Wen-Fang Zhong, doctoral student1, Simin Liu, professor2, Virginia Byers Kraus, professor3, Yu-Jie Zhang, postdoctoral fellow1, Xiang Gao, professor4, Yue-Bin Lv, assistant research fellow5, Dong Shen, doctoral student1, Xi-Ru Zhang, doctoral student1, Pei-Dong Zhang, postdoctoral fellow1, Qing-Mei Huang, masters student1, Qing Chen, masters student1, Xian-Bo Wu, professor1, Xiao-Ming Shi, research fellow5, Dong Wang, professor6, Chen Mao, professor1 Mao maochen9 at smu.edu.cn

Objectives To evaluate the associations of habitual fish oil supplementation with cardiovascular disease (CVD) and mortality in a large prospective cohort.

Design Population based, prospective cohort study.

Setting UK Biobank.

Participants A total of 427 678 men and women aged between 40 and 69 who had no CVD or cancer at baseline were enrolled between 2006 and 2010 and followed up to the end of 2018.

Main exposure All participants answered questions on the habitual use of supplements, including fish oil.

Main outcome measures All cause mortality, CVD mortality, and CVD events.

Results At baseline, 133 438 (31.2%) of the 427 678 participants reported habitual use of fish oil supplements. The multivariable adjusted hazard ratios for habitual users of fish oil versus non-users were 0.87 (95% confidence interval 0.83 to 0.90) for all cause mortality, 0.84 (0.78 to 0.91) for CVD mortality, and 0.93 (0.90 to 0.96) for incident CVD events. For CVD events, the association seemed to be stronger among those with prevalent hypertension (P for interaction=0.005).

Conclusions Habitual use of fish oil seems to be associated with a lower risk of all cause and CVD mortality and to provide a marginal benefit against CVD events among the general population.

WHAT IS ALREADY KNOWN ON THIS TOPIC

• Fish oil supplementation is common in the UK and other developed countries
• A recent meta-analysis of 13 randomised controlled trials showed a significant marginal protective effect of omega 3 fatty acid supplementation against cardiovascular disease (CVD); however, the performance of fish oil supplements in randomised controlled trials was assessed under ideal and controlled circumstances, making it difficult to generalise the findings to larger, more inclusive populations
• Complementary information on the effectiveness of fish oil supplements is needed through evaluation in real life settings of large scale cohort studies

WHAT THIS STUDY ADDS

• Habitual fish oil supplementation is associated with a 13% lower risk of all cause mortality, a 16% lower risk of CVD mortality, and a 7% lower risk of CVD events among the general population
• These findings indicate that habitual fish oil supplementation could have a marginal benefit for CVD outcomes, but further studies are needed to examine how the dose of fish oil supplements affects its clinically meaningful effectiveness