Get 20M+ Full-Text Papers For Less Than $1.50/day. Start a 14-Day Trial for You or Your Team.

Learn More →

Preventing Restenosis With Fish Oils Following Coronary Angioplasty: A Meta-analysis

Preventing Restenosis With Fish Oils Following Coronary Angioplasty: A Meta-analysis Abstract Backround: No medical therapy has been shown to reduce the rate of restenosis following percutaneous transluminal coronary angioplasty. We examined the existing evidence for the use of omega-3 fatty acids in this capacity with the tool of meta-analysis. Methods: A computerized search and a bibliographic review of published articles were performed. Abstracts were identified through journals, Index Medicus, and an unpublished listing of recent requests for fish oil for experimental use. All English-language randomized clinical trials with available reports were included in the analysis. The quality, design differences, and outcomes were evaluated for each study. Results: For four studies that used angiography to define coronary restenosis, the absolute difference in restenosis rates between treatment and control groups was 13.9% (95% confidence interval [CI], 3.2% to 24.5%). Furthermore, regression analysis revealed a positive linear relationship between the dose of omega-3 fatty acids used and the absolute difference in restenosis rates (r=.99, P<.03). When three studies that used stress testing as a means of determining restenosis rates were added to the four studies that used angiography, the risk difference was 5.1% (95% CI, —3.8% to 13.9%). Conclusions: Restenosis after coronary angioplasty is reduced by supplemental fish oils, and the extent of the observed benefit may be dependent on the dose of omega-3 fatty acids used.(Arch Intern Med. 1993;153:1595-1601) References 1. Fanelli C, Aronoff R. Restenosis following coronary angioplasty . Am Heart J. 1990;119:357-368.Crossref 2. Detre K, Holubkov R, Kelsey S, et al. Percutaneous transluminal coronary angioplasty in 1985-1986 and 1977-1981 . N Engl J Med. 1988;318:265-270.Crossref 3. MacDonald RG, Henderson MA, Hirschfield JW, et al. Patient-related variables and restenosis after percutaneous transluminal coronary angioplasty—a report from the M HEART group . Am J Cardiol. 1990;66:926-931.Crossref 4. O'Keefe JH, Rutherford BD, McConahay DR, et al. Multivessel coronary angioplasty from 1980 to 1989: procedural results and long-term outcome . J Am Coll Cardiol. 1990;16:1097-1102.Crossref 5. Nobuyoshi M, Kimura T, Nosaka H, et al. Restenosis after successful percutaneous coronary angioplasty: serial angiographic follow-up of 229 patients . J Am Coll Cardiol. 1988;12:616-623.Crossref 6. Ross R. The pathogenesis of atherosclerosis: an update . N Engl J Med. 1986; 314:488-500.Crossref 7. Lambert M, Bonan R, Cote G, et al. Multiple coronary angioplasty: a model to discriminate systemic and procedural factors related to restenosis . J Am Coll Cardiol. 1988;12:310-314.Crossref 8. Galan KM, Deligonul U, Kern MJ, Chaitman BR, Vandormael MG. Increased frequency of restenosis in patients continuing to smoke after percutaneous transluminal coronary angioplasty . Am J Cardiol. 1988;61:260-263.Crossref 9. Vandormael MG, Deligonul U, Kern MJ, et al. Multilesion coronary angioplasty: clinical and angiographic follow-up . J Am Coll Cardiol. 1987;10:246-252.Crossref 10. Guiteras VP, Bourassa MG, David PR, et al. Restenosis after successful percutaneous transluminal coronary angioplasty: the Montreal Heart Institute experience . Am J Cardiol. 1987;60:50B-55B. 11. Corcos T, David PR, Bourassa MG, Val PG, Mala LA, Waters DD. Percutaneous transluminal coronary angioplasty for the treatment of variant angina . J Am Coll Cardiol. 1985;5:1046-1054.Crossref 12. David PR, Waters DD, Scholl JM, et al. Percutaneous transluminal coronary angioplasty in patients with variant angina . Circulation. 1982;66:695-702.Crossref 13. Meyer J, Schmitz HJ, Kiesslich T, et al. Percutaneous transluminal coronary angioplasty in patients with stable and unstable angina pectoris: analysis of early and late results . Am Heart J. 1983;106:973-980.Crossref 14. Bourassa MG, Lesperance J, Eastwood C, et al. Clinical, physiologic, anatomic and procedural factors predictive of restenosis after percutaneous transluminal coronary angioplasty . J Am Coll Cardiol. 1991;18:368-376.Crossref 15. McBride W, Lange RA, Hillis LD. Restenosis after successful coronary angioplasty: pathophysiology and prevention . N Engl J Med. 1988;318:1734-1737.Crossref 16. Myler RK, Topol EJ, Shaw RE, et al. Multiple vessel coronary angioplasty: classification, results, and patterns of restenosis in 494 consecutive patients . Cathet Cardiovasc Diagn. 1987;13:1-15.Crossref 17. Block PC, Cowley MJ, Kaltenbach M, Simpson J. Percutaneous angioplasty of stenoses of bypass grafts or of bypass graft anastomotic sites . Am J Cardiol. 1984;53:666-668.Crossref 18. Corbelli J, Franco I, Hollman J, Simpfendorfer C, Galan K. Percutaneous transluminal coronary angioplasty after previous coronary bypass surgery . Am J Cardiol. 1985;56:398-403.Crossref 19. El Gamal M, Connier H, Michels R, Heijman J, Stassen E. Percutaneous transluminal coronary angioplasty of stenosed aortocoronary bypass grafts . Br Heart J. 1984;52:617-620.Crossref 20. Klein LW, Rosenblum J. Restenosis after successful percutaneous transluminal coronary angioplasty . Prog Cardiovasc Dis. 1990;32:365-382.Crossref 21. Blackshear JL, O'Callaghan WG, Califf RM. Medical approaches to prevention of restenosis after coronary angioplasty . J Am Coll Cardiol. 1987;9:834-848.Crossref 22. Hermans WRM, Rensing BJ, Strauss BH, Serruys PW. Prevention of restenosis after percutaneous coronary angioplasty: the search for a 'magic bullet.' Am Heart J. 1991;122:171-187.Crossref 23. Pompa JJ, Dehmer GJ. Care of the patient after coronary angioplasty . Ann Intern Med. 1989;110:547-559.Crossref 24. The Multicenter European Research Trial With Cilazapril After Angioplasty to Prevent Transluminal Coronary Obstruction and Restenosis (MERCATOR) Study. Does the new angiotensin converting enzyme inhibitor cilazapril prevent restenosis after percutaneous transluminal coronary angioplasty? results of the MERCATOR Study: a multicenter, randomized, double-blind placebo controlled trial . Circulation. 1992;86:100-110.Crossref 25. Schwartz L, Bourassa MG, Lesperance J, et al. Aspirin and dipyramidole in the prevention of restenosis after percutaneous transluminal coronary angioplasty . N Engl J Med. 1988;318:1714-1719.Crossref 26. Bairati I, Roy L, Meyer F. Double-blind, randomized, controlled trial of fish oil supplements in the prevention of the recurrence of stenosis after coronary angioplasty . Circulation. 1992;85:950-956.Crossref 27. Dehmer GJ, Popma JJ, Van Den Berg EK, et al. Reduction in the rate of early restenosis after coronary angioplasty by a diet supplemented with n-3 fatty acids . N Engl J Med. 1988;319:733-740.Crossref 28. Grigg LE, Kay TWH, Valentine PA, et al. Determinants of restenosis and lack of effect of dietary supplementation with eicosapentaenoic acid on the incidence of coronary artery restenosis after angioplasty . J Am Coll Cardiol. 1969;13: 665-672.Crossref 29. Kaul U, Sanghvi S, Bahl VK, Dev V, Wasir HS. Fish oil supplements for prevention of restenosis after coronary angioplasty . Int J Cardiol. 1992;35:87-93.Crossref 30. Milner MR, Gallino RA, Leffingwell A, et al. Usefulness of fish oil supplements in preventing clinical evidence of restenosis after percutaneous transluminal coronary angioplasty . Am J Cardiol. 1989;64:294-299.Crossref 31. Nye ER, Ablett MB, Robertson MC, Ilsley CDJ, Sutherland WHF. Effect of eicosapentaenoic acid on restenosis rate, clinical course and blood lipids in patients after percutaneous transluminal coronary angioplasty . Aust N Z J Med. 1990;20:549-552.Crossref 32. Reis GJ, Sipperly ME, McCabe CH, et al. Randomised trial of fish oil for prevention of restenosis after coronary angioplasty . Lancet. 1989;2:177-181.Crossref 33. Slack JD, Pinkerton CA, Van Tassel J, et al. Can oral fish oil supplement minimize re-stenosis after percutaneous transluminal coronary angioplasty? J Am Coll Cardiol. 1987;9:64A. Abstract. 34. Goldin K. Letter to the editor . N Engl J Med. 1989;320:466. 35. Reis GJ, Pasternack RC. Letter to the editor . Am J Cardiol. 1990;66:385.Crossref 36. Berger P. Letter to the editor . N Engl J Med. 1989;320:465-466.Crossref 37. Chalmers TC, Smith H Jr, Blackburn B, et al. A method for assessing the quality of a randomized control trial . Controlled Clin Trials. 1981;2:31-49.Crossref 38. Agresti A. Categorical Data Analysis . New York, NY: John Wiley & Sons Inc; 1989:367. 39. DerSimonian R, Laird N. Meta-analysis in clinical trials . Controlled Clin Trials. 1986;7:177-188.Crossref 40. Holmes DR Jr, Vliestra RE, Smith HC, et al. Restenosis after percutaneous transluminal coronary angioplasty (PTCA): a report from the PTCA registry of the NHLBI . Am J Cardiol. 1984;53:77C-81C.Crossref 41. Garrido A, Garrido F, Guerra R, Valenzuela A. Ingestion of high doses of fish oil increases the susceptibility of cellular membranes to the induction of oxidative stress . Lipids. 1989;24:833-835.Crossref 42. Meydani M, Natiello F, Goldin B, et al. Effect of long-term fish oil supplementation on vitamin E status and lipid peroxidation in women . J Nutr. 1991;121: 484-491. 43. Steinberg D, Parthasarathy S, Carew TE, Khoo JC, Witzum JL. Modifications of low-density lipoprotein that increase it atherogenicity . N Engl J Med. 1989; 320:915-924.Crossref 44. Hu ML, Frankel EN, Leibovitz BE, Tappel AL. Effect of dietary lipids and vitamin E on in vitro lipid peroxidation in rat liver and kidney homogenates . J Nutr. 1989;119:1574-1582. 45. Hu ML, Frankel EN, Tappel AL. Effect of dietary menhaden oil and vitamin E on in vivo lipid peroxidation induced by iron . Lipids. 1990;25:194-198.Crossref 46. Lenz PH, Watkins T, Bierenbaum M. Effect of dietary menhaden, canola and partially hydrogenated soy oil supplemented with vitamin E upon plasma lipids and platelet aggregation . Thromb Res. 1991;61:213-224.Crossref 47. Brown JE, Wahle KW. Effect of fish-oil and vitamin E supplementation on lipid peroxidation and whole-blood aggregation in man . Clin Chim Acta. 1990;193: 147-156.Crossref 48. O'Connor GT, Malenka DJ, Olmstead-Marsh E, Johnson PS, Hennekens CH. A meta-analysis of randomized trials of fish oil in the prevention of restenosis following coronary angioplasty . Am J Prev Med. 1992;8:186-192. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Preventing Restenosis With Fish Oils Following Coronary Angioplasty: A Meta-analysis

Loading next page...
 
/lp/american-medical-association/preventing-restenosis-with-fish-oils-following-coronary-angioplasty-a-XVAFW0Q5jE
Publisher
American Medical Association
Copyright
Copyright © 1993 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1993.00410130117012
Publisher site
See Article on Publisher Site

Abstract

Abstract Backround: No medical therapy has been shown to reduce the rate of restenosis following percutaneous transluminal coronary angioplasty. We examined the existing evidence for the use of omega-3 fatty acids in this capacity with the tool of meta-analysis. Methods: A computerized search and a bibliographic review of published articles were performed. Abstracts were identified through journals, Index Medicus, and an unpublished listing of recent requests for fish oil for experimental use. All English-language randomized clinical trials with available reports were included in the analysis. The quality, design differences, and outcomes were evaluated for each study. Results: For four studies that used angiography to define coronary restenosis, the absolute difference in restenosis rates between treatment and control groups was 13.9% (95% confidence interval [CI], 3.2% to 24.5%). Furthermore, regression analysis revealed a positive linear relationship between the dose of omega-3 fatty acids used and the absolute difference in restenosis rates (r=.99, P<.03). When three studies that used stress testing as a means of determining restenosis rates were added to the four studies that used angiography, the risk difference was 5.1% (95% CI, —3.8% to 13.9%). Conclusions: Restenosis after coronary angioplasty is reduced by supplemental fish oils, and the extent of the observed benefit may be dependent on the dose of omega-3 fatty acids used.(Arch Intern Med. 1993;153:1595-1601) References 1. Fanelli C, Aronoff R. Restenosis following coronary angioplasty . Am Heart J. 1990;119:357-368.Crossref 2. Detre K, Holubkov R, Kelsey S, et al. Percutaneous transluminal coronary angioplasty in 1985-1986 and 1977-1981 . N Engl J Med. 1988;318:265-270.Crossref 3. MacDonald RG, Henderson MA, Hirschfield JW, et al. Patient-related variables and restenosis after percutaneous transluminal coronary angioplasty—a report from the M HEART group . Am J Cardiol. 1990;66:926-931.Crossref 4. O'Keefe JH, Rutherford BD, McConahay DR, et al. Multivessel coronary angioplasty from 1980 to 1989: procedural results and long-term outcome . J Am Coll Cardiol. 1990;16:1097-1102.Crossref 5. Nobuyoshi M, Kimura T, Nosaka H, et al. Restenosis after successful percutaneous coronary angioplasty: serial angiographic follow-up of 229 patients . J Am Coll Cardiol. 1988;12:616-623.Crossref 6. Ross R. The pathogenesis of atherosclerosis: an update . N Engl J Med. 1986; 314:488-500.Crossref 7. Lambert M, Bonan R, Cote G, et al. Multiple coronary angioplasty: a model to discriminate systemic and procedural factors related to restenosis . J Am Coll Cardiol. 1988;12:310-314.Crossref 8. Galan KM, Deligonul U, Kern MJ, Chaitman BR, Vandormael MG. Increased frequency of restenosis in patients continuing to smoke after percutaneous transluminal coronary angioplasty . Am J Cardiol. 1988;61:260-263.Crossref 9. Vandormael MG, Deligonul U, Kern MJ, et al. Multilesion coronary angioplasty: clinical and angiographic follow-up . J Am Coll Cardiol. 1987;10:246-252.Crossref 10. Guiteras VP, Bourassa MG, David PR, et al. Restenosis after successful percutaneous transluminal coronary angioplasty: the Montreal Heart Institute experience . Am J Cardiol. 1987;60:50B-55B. 11. Corcos T, David PR, Bourassa MG, Val PG, Mala LA, Waters DD. Percutaneous transluminal coronary angioplasty for the treatment of variant angina . J Am Coll Cardiol. 1985;5:1046-1054.Crossref 12. David PR, Waters DD, Scholl JM, et al. Percutaneous transluminal coronary angioplasty in patients with variant angina . Circulation. 1982;66:695-702.Crossref 13. Meyer J, Schmitz HJ, Kiesslich T, et al. Percutaneous transluminal coronary angioplasty in patients with stable and unstable angina pectoris: analysis of early and late results . Am Heart J. 1983;106:973-980.Crossref 14. Bourassa MG, Lesperance J, Eastwood C, et al. Clinical, physiologic, anatomic and procedural factors predictive of restenosis after percutaneous transluminal coronary angioplasty . J Am Coll Cardiol. 1991;18:368-376.Crossref 15. McBride W, Lange RA, Hillis LD. Restenosis after successful coronary angioplasty: pathophysiology and prevention . N Engl J Med. 1988;318:1734-1737.Crossref 16. Myler RK, Topol EJ, Shaw RE, et al. Multiple vessel coronary angioplasty: classification, results, and patterns of restenosis in 494 consecutive patients . Cathet Cardiovasc Diagn. 1987;13:1-15.Crossref 17. Block PC, Cowley MJ, Kaltenbach M, Simpson J. Percutaneous angioplasty of stenoses of bypass grafts or of bypass graft anastomotic sites . Am J Cardiol. 1984;53:666-668.Crossref 18. Corbelli J, Franco I, Hollman J, Simpfendorfer C, Galan K. Percutaneous transluminal coronary angioplasty after previous coronary bypass surgery . Am J Cardiol. 1985;56:398-403.Crossref 19. El Gamal M, Connier H, Michels R, Heijman J, Stassen E. Percutaneous transluminal coronary angioplasty of stenosed aortocoronary bypass grafts . Br Heart J. 1984;52:617-620.Crossref 20. Klein LW, Rosenblum J. Restenosis after successful percutaneous transluminal coronary angioplasty . Prog Cardiovasc Dis. 1990;32:365-382.Crossref 21. Blackshear JL, O'Callaghan WG, Califf RM. Medical approaches to prevention of restenosis after coronary angioplasty . J Am Coll Cardiol. 1987;9:834-848.Crossref 22. Hermans WRM, Rensing BJ, Strauss BH, Serruys PW. Prevention of restenosis after percutaneous coronary angioplasty: the search for a 'magic bullet.' Am Heart J. 1991;122:171-187.Crossref 23. Pompa JJ, Dehmer GJ. Care of the patient after coronary angioplasty . Ann Intern Med. 1989;110:547-559.Crossref 24. The Multicenter European Research Trial With Cilazapril After Angioplasty to Prevent Transluminal Coronary Obstruction and Restenosis (MERCATOR) Study. Does the new angiotensin converting enzyme inhibitor cilazapril prevent restenosis after percutaneous transluminal coronary angioplasty? results of the MERCATOR Study: a multicenter, randomized, double-blind placebo controlled trial . Circulation. 1992;86:100-110.Crossref 25. Schwartz L, Bourassa MG, Lesperance J, et al. Aspirin and dipyramidole in the prevention of restenosis after percutaneous transluminal coronary angioplasty . N Engl J Med. 1988;318:1714-1719.Crossref 26. Bairati I, Roy L, Meyer F. Double-blind, randomized, controlled trial of fish oil supplements in the prevention of the recurrence of stenosis after coronary angioplasty . Circulation. 1992;85:950-956.Crossref 27. Dehmer GJ, Popma JJ, Van Den Berg EK, et al. Reduction in the rate of early restenosis after coronary angioplasty by a diet supplemented with n-3 fatty acids . N Engl J Med. 1988;319:733-740.Crossref 28. Grigg LE, Kay TWH, Valentine PA, et al. Determinants of restenosis and lack of effect of dietary supplementation with eicosapentaenoic acid on the incidence of coronary artery restenosis after angioplasty . J Am Coll Cardiol. 1969;13: 665-672.Crossref 29. Kaul U, Sanghvi S, Bahl VK, Dev V, Wasir HS. Fish oil supplements for prevention of restenosis after coronary angioplasty . Int J Cardiol. 1992;35:87-93.Crossref 30. Milner MR, Gallino RA, Leffingwell A, et al. Usefulness of fish oil supplements in preventing clinical evidence of restenosis after percutaneous transluminal coronary angioplasty . Am J Cardiol. 1989;64:294-299.Crossref 31. Nye ER, Ablett MB, Robertson MC, Ilsley CDJ, Sutherland WHF. Effect of eicosapentaenoic acid on restenosis rate, clinical course and blood lipids in patients after percutaneous transluminal coronary angioplasty . Aust N Z J Med. 1990;20:549-552.Crossref 32. Reis GJ, Sipperly ME, McCabe CH, et al. Randomised trial of fish oil for prevention of restenosis after coronary angioplasty . Lancet. 1989;2:177-181.Crossref 33. Slack JD, Pinkerton CA, Van Tassel J, et al. Can oral fish oil supplement minimize re-stenosis after percutaneous transluminal coronary angioplasty? J Am Coll Cardiol. 1987;9:64A. Abstract. 34. Goldin K. Letter to the editor . N Engl J Med. 1989;320:466. 35. Reis GJ, Pasternack RC. Letter to the editor . Am J Cardiol. 1990;66:385.Crossref 36. Berger P. Letter to the editor . N Engl J Med. 1989;320:465-466.Crossref 37. Chalmers TC, Smith H Jr, Blackburn B, et al. A method for assessing the quality of a randomized control trial . Controlled Clin Trials. 1981;2:31-49.Crossref 38. Agresti A. Categorical Data Analysis . New York, NY: John Wiley & Sons Inc; 1989:367. 39. DerSimonian R, Laird N. Meta-analysis in clinical trials . Controlled Clin Trials. 1986;7:177-188.Crossref 40. Holmes DR Jr, Vliestra RE, Smith HC, et al. Restenosis after percutaneous transluminal coronary angioplasty (PTCA): a report from the PTCA registry of the NHLBI . Am J Cardiol. 1984;53:77C-81C.Crossref 41. Garrido A, Garrido F, Guerra R, Valenzuela A. Ingestion of high doses of fish oil increases the susceptibility of cellular membranes to the induction of oxidative stress . Lipids. 1989;24:833-835.Crossref 42. Meydani M, Natiello F, Goldin B, et al. Effect of long-term fish oil supplementation on vitamin E status and lipid peroxidation in women . J Nutr. 1991;121: 484-491. 43. Steinberg D, Parthasarathy S, Carew TE, Khoo JC, Witzum JL. Modifications of low-density lipoprotein that increase it atherogenicity . N Engl J Med. 1989; 320:915-924.Crossref 44. Hu ML, Frankel EN, Leibovitz BE, Tappel AL. Effect of dietary lipids and vitamin E on in vitro lipid peroxidation in rat liver and kidney homogenates . J Nutr. 1989;119:1574-1582. 45. Hu ML, Frankel EN, Tappel AL. Effect of dietary menhaden oil and vitamin E on in vivo lipid peroxidation induced by iron . Lipids. 1990;25:194-198.Crossref 46. Lenz PH, Watkins T, Bierenbaum M. Effect of dietary menhaden, canola and partially hydrogenated soy oil supplemented with vitamin E upon plasma lipids and platelet aggregation . Thromb Res. 1991;61:213-224.Crossref 47. Brown JE, Wahle KW. Effect of fish-oil and vitamin E supplementation on lipid peroxidation and whole-blood aggregation in man . Clin Chim Acta. 1990;193: 147-156.Crossref 48. O'Connor GT, Malenka DJ, Olmstead-Marsh E, Johnson PS, Hennekens CH. A meta-analysis of randomized trials of fish oil in the prevention of restenosis following coronary angioplasty . Am J Prev Med. 1992;8:186-192.

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Jul 12, 1993

References