Impact of Eicosapentaenoic Acid on Cardiovascular Outcomes After Acute Coronary Syndrome: A Systematic Review and Meta-Analysis of Randomized Clinical Trials Publisher



Fallahtafti P¹ ; Nayebirad S¹ ; Karimi E¹ ; Hassanzadeh A² ; Habibzadeh A³ ; Safaee E⁴ ; Ebrahimi R⁵ ; Tajdini M¹ ; Najafi K⁶ ; Askari MK⁷ ; Harrison A⁸ ; Nelson JR⁹ ; Hosseini K¹⁰ Show Affiliations
Source: Cardiology Plus Published:2024

Abstract

Background and purpose: Studies show that individuals recovering from acute coronary syndrome (ACS) benefit from intensive lipid-lowering treatment, which offers better protection against cardiovascular events than standard regimens. While the benefits of polyunsaturated fatty acids (PUFAs), particularly eicosapentaenoic acid (EPA), in coronary artery disease are well-established, their use in ACS patients remains debated. This systematic review and meta-analysis aimed to evaluate the effects of EPA supplementation on cardiovascular outcomes in ACS patients. Methods: A systematic search was conducted in PubMed, Embase, Scopus, Cochrane Library, and ClinicalTrials.gov from inception to March 22, 2024, focusing on randomized clinical trials (RCTs) and post hoc analyses of adults with ACS examining the effects of adding EPA to statin therapy. The risk of bias was assessed using the Cochrane risk of bias-2 tool. Data synthesis included calculating relative risks (RR) and assessing heterogeneity with I2 and Cochran's Q test, using fixed or random-effects models as appropriate. The primary outcome was a composite of cardiovascular death, non-fatal myocardial infarction, and stroke. Results: A total of 1,333 subjects with recent ACS were included across five RCTs, with 653 receiving standard statin therapy and 680 receiving statins plus EPA. EPA supplementation trended toward reduced all-cause and cardiac death. Meta-analysis revealed a significant reduction in composite outcomes for the EPA group compared to controls (RR: 0.67, 95% confidential interval: 0.45-1.00, P = 0.04). No significant differences were found in re-infarction, coronary revascularization, or atherosclerotic plaque characteristics between the groups. Conclusions: Our study shows that adding EPA to statins after recent ACS reduces cardiovascular events. Despite limitations, our findings support early EPA use in ACS patients. © 2024 China Heart House.