Effect of low doses of n-3 fatty acids on cardiovascular diseases in 4,837 post-myocardial infarction patients: Design and baseline characteristics of the Alpha Omega Trial

J.M. Geleijnse, E.J. Giltay, E.G. Schouten, J. de Goede, L.M. Oude Griep, A.M. Teitsma-Jansen, M.B. Katan, D. Kromhout

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Abstract

Background Weekly fish consumption has been related to a lower risk of fatal coronary heart disease (CHD) and incident stroke in populations with a low fish intake. This relation has mainly been attributed to n-3 fatty acids in fish, that is, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). It is at present unclear whether alpha-linolenic acid (ALA), a n-3 fatty acid from vegetable origin, could also be protective against cardiovascular diseases (CVDs). There is a need for food-based trials to establish the efficacy of low doses of n-3 fatty acids in CVD prevention. Objectives The aim of the study was to evaluate the effect of an additional daily intake of 400 mg of EPA + DHA and 2 g of ALA on CVD morbidity and mortality in free-living subjects with a history of myocardial infarction. Design The multicenter Alpha Omega Trial is a randomized, double-blind, placebo-controlled trial with a 2 x 2 factorial design. Between May 2002 and December 2006, we enrolled a total of 4,837 men and women aged 60 through 80 who experienced a myocardial infarction within 10 years before entering the study. Subjects were randomized to 1 of 4 margarine spreads that were enriched with EPA + DHA and/or ALA, or placebo. Compliance was monitored via tub counts and assessment of n-3 fatty acids in plasma. Subjects were observed for 40 months for the occurrence of fatal and nonfatal CVD. Results The cohort was on average 69 years old at the start of the study and comprised 22% women. Subjects had their (last) myocardial infarction approximately 4 years before enrolment. Mean body mass index was 27.7 kg/m(2), and 17% smoked. Average serum total and high-density lipoprotein cholesterol were 4.7 and 1.3 mmol/L, respectively, and 85% used statins. Mean blood pressure was 142/80 mm Hg, and most subjects were on antihypertensive medication (88%). Diabetes mellitus was reported by 17% of the subjects, and 7% reported a history of stroke. The overall mortality rate during the trial period was 23 per 1,000 person-years, with approximately 40% due to CVD. Current status Follow-up of the patients was completed in November 2009, and findings will be reported in the second part of 2010. (Am Heart J 2010; 159: 539-546. e2.)
Original languageEnglish
Pages (from-to)539-546
JournalAmerican Heart Journal
Volume159
DOIs
Publication statusPublished - 2010

Fingerprint

Omega-3 Fatty Acids
Cardiovascular Diseases
Myocardial Infarction
alpha-Linolenic Acid
Eicosapentaenoic Acid
Docosahexaenoic Acids
Fishes
Stroke
Placebos
Margarine
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Mortality
Vegetables
HDL Cholesterol
Antihypertensive Agents
Compliance
Coronary Disease
Diabetes Mellitus
Body Mass Index
Blood Pressure

Keywords

  • coronary-heart-disease
  • serum cholesteryl esters
  • fish consumption
  • linolenic acid
  • eicosapentaenoic acid
  • myocardial-infarction
  • secondary-prevention
  • risk
  • metaanalysis
  • mortality

Cite this

Geleijnse, J.M. ; Giltay, E.J. ; Schouten, E.G. ; de Goede, J. ; Oude Griep, L.M. ; Teitsma-Jansen, A.M. ; Katan, M.B. ; Kromhout, D. / Effect of low doses of n-3 fatty acids on cardiovascular diseases in 4,837 post-myocardial infarction patients: Design and baseline characteristics of the Alpha Omega Trial. In: American Heart Journal. 2010 ; Vol. 159. pp. 539-546.
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abstract = "Background Weekly fish consumption has been related to a lower risk of fatal coronary heart disease (CHD) and incident stroke in populations with a low fish intake. This relation has mainly been attributed to n-3 fatty acids in fish, that is, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). It is at present unclear whether alpha-linolenic acid (ALA), a n-3 fatty acid from vegetable origin, could also be protective against cardiovascular diseases (CVDs). There is a need for food-based trials to establish the efficacy of low doses of n-3 fatty acids in CVD prevention. Objectives The aim of the study was to evaluate the effect of an additional daily intake of 400 mg of EPA + DHA and 2 g of ALA on CVD morbidity and mortality in free-living subjects with a history of myocardial infarction. Design The multicenter Alpha Omega Trial is a randomized, double-blind, placebo-controlled trial with a 2 x 2 factorial design. Between May 2002 and December 2006, we enrolled a total of 4,837 men and women aged 60 through 80 who experienced a myocardial infarction within 10 years before entering the study. Subjects were randomized to 1 of 4 margarine spreads that were enriched with EPA + DHA and/or ALA, or placebo. Compliance was monitored via tub counts and assessment of n-3 fatty acids in plasma. Subjects were observed for 40 months for the occurrence of fatal and nonfatal CVD. Results The cohort was on average 69 years old at the start of the study and comprised 22{\%} women. Subjects had their (last) myocardial infarction approximately 4 years before enrolment. Mean body mass index was 27.7 kg/m(2), and 17{\%} smoked. Average serum total and high-density lipoprotein cholesterol were 4.7 and 1.3 mmol/L, respectively, and 85{\%} used statins. Mean blood pressure was 142/80 mm Hg, and most subjects were on antihypertensive medication (88{\%}). Diabetes mellitus was reported by 17{\%} of the subjects, and 7{\%} reported a history of stroke. The overall mortality rate during the trial period was 23 per 1,000 person-years, with approximately 40{\%} due to CVD. Current status Follow-up of the patients was completed in November 2009, and findings will be reported in the second part of 2010. (Am Heart J 2010; 159: 539-546. e2.)",
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Effect of low doses of n-3 fatty acids on cardiovascular diseases in 4,837 post-myocardial infarction patients: Design and baseline characteristics of the Alpha Omega Trial. / Geleijnse, J.M.; Giltay, E.J.; Schouten, E.G.; de Goede, J.; Oude Griep, L.M.; Teitsma-Jansen, A.M.; Katan, M.B.; Kromhout, D.

In: American Heart Journal, Vol. 159, 2010, p. 539-546.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Effect of low doses of n-3 fatty acids on cardiovascular diseases in 4,837 post-myocardial infarction patients: Design and baseline characteristics of the Alpha Omega Trial

AU - Geleijnse, J.M.

AU - Giltay, E.J.

AU - Schouten, E.G.

AU - de Goede, J.

AU - Oude Griep, L.M.

AU - Teitsma-Jansen, A.M.

AU - Katan, M.B.

AU - Kromhout, D.

PY - 2010

Y1 - 2010

N2 - Background Weekly fish consumption has been related to a lower risk of fatal coronary heart disease (CHD) and incident stroke in populations with a low fish intake. This relation has mainly been attributed to n-3 fatty acids in fish, that is, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). It is at present unclear whether alpha-linolenic acid (ALA), a n-3 fatty acid from vegetable origin, could also be protective against cardiovascular diseases (CVDs). There is a need for food-based trials to establish the efficacy of low doses of n-3 fatty acids in CVD prevention. Objectives The aim of the study was to evaluate the effect of an additional daily intake of 400 mg of EPA + DHA and 2 g of ALA on CVD morbidity and mortality in free-living subjects with a history of myocardial infarction. Design The multicenter Alpha Omega Trial is a randomized, double-blind, placebo-controlled trial with a 2 x 2 factorial design. Between May 2002 and December 2006, we enrolled a total of 4,837 men and women aged 60 through 80 who experienced a myocardial infarction within 10 years before entering the study. Subjects were randomized to 1 of 4 margarine spreads that were enriched with EPA + DHA and/or ALA, or placebo. Compliance was monitored via tub counts and assessment of n-3 fatty acids in plasma. Subjects were observed for 40 months for the occurrence of fatal and nonfatal CVD. Results The cohort was on average 69 years old at the start of the study and comprised 22% women. Subjects had their (last) myocardial infarction approximately 4 years before enrolment. Mean body mass index was 27.7 kg/m(2), and 17% smoked. Average serum total and high-density lipoprotein cholesterol were 4.7 and 1.3 mmol/L, respectively, and 85% used statins. Mean blood pressure was 142/80 mm Hg, and most subjects were on antihypertensive medication (88%). Diabetes mellitus was reported by 17% of the subjects, and 7% reported a history of stroke. The overall mortality rate during the trial period was 23 per 1,000 person-years, with approximately 40% due to CVD. Current status Follow-up of the patients was completed in November 2009, and findings will be reported in the second part of 2010. (Am Heart J 2010; 159: 539-546. e2.)

AB - Background Weekly fish consumption has been related to a lower risk of fatal coronary heart disease (CHD) and incident stroke in populations with a low fish intake. This relation has mainly been attributed to n-3 fatty acids in fish, that is, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). It is at present unclear whether alpha-linolenic acid (ALA), a n-3 fatty acid from vegetable origin, could also be protective against cardiovascular diseases (CVDs). There is a need for food-based trials to establish the efficacy of low doses of n-3 fatty acids in CVD prevention. Objectives The aim of the study was to evaluate the effect of an additional daily intake of 400 mg of EPA + DHA and 2 g of ALA on CVD morbidity and mortality in free-living subjects with a history of myocardial infarction. Design The multicenter Alpha Omega Trial is a randomized, double-blind, placebo-controlled trial with a 2 x 2 factorial design. Between May 2002 and December 2006, we enrolled a total of 4,837 men and women aged 60 through 80 who experienced a myocardial infarction within 10 years before entering the study. Subjects were randomized to 1 of 4 margarine spreads that were enriched with EPA + DHA and/or ALA, or placebo. Compliance was monitored via tub counts and assessment of n-3 fatty acids in plasma. Subjects were observed for 40 months for the occurrence of fatal and nonfatal CVD. Results The cohort was on average 69 years old at the start of the study and comprised 22% women. Subjects had their (last) myocardial infarction approximately 4 years before enrolment. Mean body mass index was 27.7 kg/m(2), and 17% smoked. Average serum total and high-density lipoprotein cholesterol were 4.7 and 1.3 mmol/L, respectively, and 85% used statins. Mean blood pressure was 142/80 mm Hg, and most subjects were on antihypertensive medication (88%). Diabetes mellitus was reported by 17% of the subjects, and 7% reported a history of stroke. The overall mortality rate during the trial period was 23 per 1,000 person-years, with approximately 40% due to CVD. Current status Follow-up of the patients was completed in November 2009, and findings will be reported in the second part of 2010. (Am Heart J 2010; 159: 539-546. e2.)

KW - coronary-heart-disease

KW - serum cholesteryl esters

KW - fish consumption

KW - linolenic acid

KW - eicosapentaenoic acid

KW - myocardial-infarction

KW - secondary-prevention

KW - risk

KW - metaanalysis

KW - mortality

U2 - 10.1016/j.ahj.2009.12.033

DO - 10.1016/j.ahj.2009.12.033

M3 - Article

VL - 159

SP - 539

EP - 546

JO - American Heart Journal

JF - American Heart Journal

SN - 0002-8703

ER -