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A Meta-analysis

James P. Gapinski, MD; Jerome V. VanRuiswyk, MD, MS; Gustavo R. Heudebert, MD; Gordon S. Schectman, MD

Arch Intern Med. 1993;153(13):1595-1601.

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 Abstracts were identified through journals, Index Medicus, and an unpublished listing of recent requests for fish oil for experimental use.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)

Author Affiliations
From the Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Zablocki Veterans Affairs Medical Center, Milwaukee.

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