High-dose omega-3 fatty acids after MI improved function of the heart and reduced scarring in the undamaged muscle as well as markers of systemic inflammation, the OMEGA-REMODEL randomized clinical trial showed.
Patients who received prescription fish oil pills (Lovaza) each day for 6 months following acute myocardial infarction (MI) saw a reduction of left ventricular systolic volume index by an average 5.8% (P=0.017), and of noninfarct myocardial fibrosis by 5.6% (P=0.026) compared with placebo-treated patients, Raymond Y. Kwong, MD, MPH, of Brigham and Women's Hospital and Harvard in Boston, and colleagues reported in Circulation.
Left ventricular ejection fraction showed a nonsignificant trend in favor of fish oil (4.8% versus 2.1% improvement, P=0.073) overall, but all three outcomes showed a dose-response effect at higher serum levels of omega-3 and constituent fatty acids.
In addition, patients in the treatment arm experienced significant reductions in serum biomarkers of systemic and vascular inflammation (8.1% and 7.9% reduction in myeloperoxidase and ST2, respectively).
The cardiac remodeling benefits from omega-3 fatty acids may offer a significant clinical impact and warrants further clinical studies, Kwong told MedPage Today.
"Therapies that can improve healing of the heart or prevent adverse remodeling by suppressing inflammation remain very limited," he said. "There have been other drugs in the past that attempted to suppress inflammation after a heart attack and turned out to be harmful."
"So omega-3 fatty acids, if it continues to offer clinical benefits in larger scale studies, may offer hope for a treatment option that can protect a patient's heart after a heart attack."
The multicenter, double-blind, placebo-controlled trial included 358 patients, ages 21 and older, from three tertiary care centers in Boston who had a heart attack within the previous month and were randomly assigned to 6 months of 4 grams of omega-3 fatty acids (n=180) or placebo (n=178).
Those who experienced MI secondary to a cardiac procedure, were pregnant, had a life expectancy less than 1 year, or had another clinical indication for omega-3 fatty acids treatment or absolute contraindications to cardiac MRI were excluded from the study.
Patients completed pretreatment visits at 14 to 28 days, as well as a post-treatment visit at 6 months after index acute MI. During these in-person sessions Kwong and colleagues collected data including coronary risk profile, detailed events of index MI, standardized lifestyle and dietary questionnaires, and blood samples.
Throughout the study period, investigators also conducted scripted telephone interviews with each patient every 2 months in order to assess for tolerance to study drug and confirm pill counts. Patients received lifestyle counseling and were monitored to ensure that their daily pill did not interfere with their existing drug regimens.
No treatment-related adverse events occurred.
Kwong and colleagues used cardiac magnetic resonance imaging (MRI) at baseline, as well as after 6 months of treatment, to assess cardiac structure and tissue characteristics.
Limitations to the study included the small number of patients who completed the post-treatment follow-up visit, as well as the fact that over-the-counter fish oils are widely available and supplementation by patients could have potentially influenced results.
Also, "the absolute percent changes of left ventricular end-systolic volume index and extracellular volume fraction (a surrogate of noninfarct myocardial fibrosis) from omega-3 fatty acid treatment, started at 2 to 4 weeks post-MI, were only modest in comparison with guideline clinical care," the researchers acknowledged.
But, Kwong noted, "Heart failure is still a major problem after a heart attack despite all the therapy we have and the advances in interventional care."
"Our findings show that omega-3 fatty acids taken at 4 grams a day for 6 months are a safe and effective treatment in improving cardiac remodeling after a heart attack. It may be promising in reducing the incidence of patients' heart failure or death after a heart attack, which remain major healthcare burdens to these patients," he told MedPage Today.
No financial disclosures were reported.
- Reviewed by F. Perry Wilson, MD, MSCE Assistant Professor, Section of Nephrology, Yale School of Medicine