A meta-analysis of randomized controlled trials and prospective cohort studies of eicosapentaenoic and docosahexaenoic long-chain omega-3 fatty acids and coronary heart disease risk

I really hate these literature searches and meta-analysis, they always seem to need more followup to be useful rather than doing it right in the first place and doing some real research. Regardless, I bet your doctor does nothing with this information. I assume higher CHD risk pretty much correlates to higher stroke risk, to be confirmed with your doctor.
A. Because s/he never read it.
B. Because s/he could not be bothered to understand how to implement it in a protocol.
C. It is not my job. I am waiting for SOMEONE ELSE TO SOLVE THE PROBLEM?.

A meta-analysis of randomized controlled trials and prospective cohort studies of eicosapentaenoic and docosahexaenoic long-chain omega-3 fatty acids and coronary heart disease risk

Mayo Clinic Proceedings, 01/17/2017 Alexander DD, et al.

The target of this study was to assess the impact of eicosapentaenoic and docosahexaenoic acid (EPA+DHA) on coronary heart disease (CHD), and to lead meta–analyses of prospective cohort studies to estimate the association between EPA+DHA consumption and CHD risk. Outcomes show that EPA+DHA might be connected with lessening CHD risk, with a greater benefit found among higher–risk populations in RCTs.

Methods

• For this study they design a systematic literature search. From January 1, 1947, to November 2, 2015 they search Ovid/Medline, PubMed, Embase, and the Cochrane Library, 18 RCTs and 16 prospective cohort studies examining EPA+DHA from foods or supplements and CHD, including myocardial infarction, sudden cardiac death, coronary death, and angina, were recognized.
• Random–effects meta–analysis models were utilized to generate summary relative risk estimates (SRREs) and 95% CIs.
• Heterogeneity was analyzed in subgroup and sensitivity examinations and by meta–regression.
• Dose–response was assessed in stratified dose or consumption investigations.
• Publication bias evaluations were performed.

Results

• Among RCTs, there was a nonstatistically significant decrease in CHD risk with EPA+DHA provision (SRRE=0.94; 95% CI, 0.85–1.05).
• Subgroup examinations of information from RCTs demonstrated a statistically significant CHD risk decrease with EPA+DHA provision among higher–risk populations, including participants with elevated triglyceride levels (SRRE=0.84; 95% CI, 0.72–0.98) and elevated low–density lipoprotein cholesterol (SRRE=0.86; 95% CI, 0.76–0.98).
• Meta–analysis of information from prospective cohort studies resulted in a statistically significant SRRE of 0.82 (95% CI, 0.74–0.92) for higher consumptions of EPA+DHA and risk of any CHD event.

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Study of Israelis and Palestinians calls for rethinking how HDL protects against coronary heart disease

Can no one get out of this fixation on cholesterol?  You fucking idiots, cholesterol is not the problem, inflammation is, which grabs the cholesterol out of the bloodstream packing it into plaque.  Learn about cause and effect and stop trying to force statins to be the only solution.
http://medicalxpress.com/news/2016-08-israelis-palestinians-rethinking-hdl-coronary.html

The idea that plasma high-density lipoprotein cholesterol (HDL-C) is protective against coronary heart disease has been part of medical conventional wisdom for five decades. HDL-C has traditionally been considered the most important component of so-called "good cholesterol" HDL. However, drug trials that increased HDL-C have failed to support a causal role for the amount of cholesterol carried in HDL in reducing the risk of coronary heart disease.

With advances in the separation of lipoproteins by size and functionality, research has intensified to identify HDL measures that may be better predictors of coronary heart disease than the traditional HDL-C. Recent evidence suggests that small, dense, protein-rich particles in HDL may be more atheroprotective than large, buoyant cholesterol-rich particles.
To explore this further, 274 Arabs and 230 Jews residing in Jerusalem were recruited for a new study by researchers at the Braun School of Public Health in the Hebrew University of Jerusalem's Faculty of Medicine. This work, led by Prof. Jeremy Kark of the Hebrew University-Hadassah Braun School of Public Health and Community Medicine, was undertaken by Dr. Chobufo Ditah, a physician from Cameroon, as his thesis for the Braun School's International Masters of Public Health program.
The researchers used Nuclear Magnetic Resonance (NMR) spectroscopy to identify the numbers and sizes of plasma HDL particles, and helical CT-scanning to identify calcification in their coronary arteries, reflecting the overall burden of coronary atherosclerosis. With these data in hand, they looked for associations between the concentrations and sizes of different HDL particles, and coronary artery calcification.
Their findings, published in the prestigious journal Atherosclerosis, showed a statistically significant inverse association of both the number of HDL particles (HDL-P) and the concentration of small and medium-sized HDL particles (MS-HDL-P) with coronary artery calcification, after adjusting for age, statin use, smoking, and other factors. There was no association between large HDL-P and coronary artery calcification in either population group. The association with HDL-C was weaker and inconsistent between men and women.
"Our findings indicate that HDL-P and MS-HDL-P are better independent markers of coronary artery disease, as reflected by coronary artery calcification, than HDL-C, at least in this bi-ethnic population of Israelis and Palestinians," said Dr. Chobufo Ditah.
"These findings support previous reports, based on studies in other population groups, suggesting that small dense HDL particles are protectively associated with risk of coronary heart disease. The consistency of this finding in a new population of urban Arabs and Jews, using different disease outcomes and different separation methods, add more strength to those findings," added Dr Ditah.
"With a better understanding of HDL's complexity and a better ability to measure its components, it is now possible to move past HDL-C to more refined measures that better reflect HDL's role in coronary heart disease risk. Based on the accumulating evidence, incorporation of MS-HDL-P or HDL-P into the routine prediction of coronary heart disease risk should be considered," said Prof Jeremy Kark.

Explore further: Some HDL, or 'good' cholesterol, may not protect against heart disease

More information: Small and medium sized HDL particles are protectively associated with coronary calcification in a cross-sectional population-based sample. Atherosclerosis, Volume 251, August 2016, Pages 124–131. Chobufo Ditah, James Otvos, Hisham Nassar, Dorith Shaham, Ronit Sinnreich, Jeremy D. Kark. DOI: 10.1016/j.atherosclerosis.2016.06.010

Provided by: Hebrew University of Jerusalem