No effect on n-3 fatty acids supplementation on NT-proBNP after myocardial infaction: THe Alpha Omega Trial

BACKGROUND: heart failure is a major risk factor for cardiovascular mortality, for which n-3 fatty acids may have beneficial effects. We examined the effect of marine eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), and plant-derived alpha-linolenic acid (ALA) on N-Terminal-pro Brain Natriuretic Peptide (NT-proBNP), a biomarker of heart failure. METHODS: we randomly assigned 4837 post-myocardial infarction patients, aged 60-80 years (82% men), to margarines supplemented with a targeted additional intake of 400¿mg/day EPA and DHA, 2¿g/day ALA, EPA-DHA plus ALA, or placebo for 40 months. In a random selection of 639 patients, NT-proBNP was determined both at baseline and at the end of follow-up. NT-proBNP was loge-transformed and analysed by type of treatment using analysis of covariance adjusting for baseline NT-proNBP. RESULTS: patients consumed on average 19.8¿g margarine/day, providing an additional amount of 238¿mg/day EPA with 158¿mg/day DHA, 1.98¿g/day ALA, or both, in the active-treatment groups. In the placebo group, the geometric mean level NT-proBNP increased from 245¿ng/l (95%-confidence interval [CI]: 207-290) to 294¿ng/l (95%-CI: 244-352) after 40 months (p¿=¿0.001). NT-proBNP levels were not affected by ALA (+8% versus placebo; 95%-CI: -8% to +25%; p¿=¿0.34), EPA-DHA (+2% versus placebo; 95%-CI: -14% to +18%; p¿=¿0.78), nor EPA-DHA plus ALA (+9% versus placebo; 95%-CI: -8% to +25%; p¿=¿0.31) treatment. CONCLUSIONS: supplementation with modest amounts of EPA-DHA, with or without ALA, did not have a significant effect on NT-proBNP levels in patients with a history of myocardial infarction.