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      Effects of ω-3 Polyunsaturated Fatty Acids on Coronary Atherosclerosis and Inflammation: A Systematic Review and Meta-Analysis

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          Abstract

          Background and Purpose

          Multiple guidelines suggest the ω-3 polyunsaturated fatty acids (ω-3 PUFAs) help to prevent major vascular events of coronary heart disease (CHD), but the data on large trials of ω-3 fatty acids are controversial. We reviewed the available evidence to determine the effect of ω-3 PUFAs on coronary atherosclerosis.

          Materials and Methods

          Literature were from online databases. Randomized controlled trials (RCTs) or observational studies were acceptable. Quantitative data synthesis was conducted using R version 4.1.2. Each outcome was calculated using standardized mean difference (SMD) in a random-effect model. Sensitivity analysis was conducted for each outcome. A total of 21 RCTs and 1 observational study with 2,277 participants were included.

          Results

          Meta-analysis indicated a benefit of ω-3 PUFAs on coronary atherosclerosis, namely, (1) ω-3 PUFAs can reduce the atherosclerotic plaque volume (SMD −0.18; 95% CI −0.31 to −0.05); (2) ω-3 PUFAs can help reduce the loss of the diameter of the narrowest segments of coronary arteries in patients with CHD (SMD 0.29; 95% CI, 0.05–0.53); (3) ω-3 PUFAs do not have significant effect on volume of lipid plaque in coronary arteries (SMD −1.18; 95% CI −2.95 to 0.58), volume of fiber plaque (SMD 0.26; 95% CI −0.81 to 1.33), and calcified plaque (SMD 0.17; 95% CI −0.55 to 0.89); and (4) ω-3 PUFAs had no significant effect on endothelial inflammatory factors in peripheral blood.

          Conclusions

          We confirmed that ω-3 PUFAs benefit patients with CHD by reducing the progression of coronary atherosclerosis. We indicated that the benefits were not caused by reducing endothelial inflammations of coronary arteries.

          Systematic Review Registration

          https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021285139, identifier: CRD42021285139.

          Graphical Abstract

          In order to increase the exposure of our work, we made a graphical abstract: ω-3 PUFAs (ω-3 polyunsaturated fatty acid) reduce coronary atherosclerotic plaques growth and relieve the lesions process of the most stenotic segment of the coronary artery. However, the effects on all main compositions of atherosclerotic plaques (fiberboard, calcified plaque, and lipid plaque) are not statistically significant. Serum soluble vascular cell adhesion molecule-1 (sVCAM-1) level and activation percentage of von Willebrand factor (VWF%) are not significantly affected. The mechanism of ω-3 PUFAs on coronary atherosclerosis may need further studies.

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          Most cited references70

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          Measuring inconsistency in meta-analyses.

          Julian P. T. Higgins, Simon Thompson, Jonathan Deeks … (2003)
          Article 0 comments Cited 10588 times – based on 0 reviews     Review now
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            The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration

            Alessandro Liberati, Douglas G. Altman, Jennifer Tetzlaff … (2010)
            Systematic reviews and meta-analyses are essential to summarise evidence relating to efficacy and safety of healthcare interventions accurately and reliably. The clarity and transparency of these reports, however, are not optimal. Poor reporting of systematic reviews diminishes their value to clinicians, policy makers, and other users. Since the development of the QUOROM (quality of reporting of meta-analysis) statement—a reporting guideline published in 1999—there have been several conceptual, methodological, and practical advances regarding the conduct and reporting of systematic reviews and meta-analyses. Also, reviews of published systematic reviews have found that key information about these studies is often poorly reported. Realising these issues, an international group that included experienced authors and methodologists developed PRISMA (preferred reporting items for systematic reviews and meta-analyses) as an evolution of the original QUOROM guideline for systematic reviews and meta-analyses of evaluations of health care interventions. The PRISMA statement consists of a 27-item checklist and a four-phase flow diagram. The checklist includes items deemed essential for transparent reporting of a systematic review. In this explanation and elaboration document, we explain the meaning and rationale for each checklist item. For each item, we include an example of good reporting and, where possible, references to relevant empirical studies and methodological literature. The PRISMA statement, this document, and the associated website (www.prisma-statement.org/) should be helpful resources to improve reporting of systematic reviews and meta-analyses.
            Article 0 comments Cited 3729 times – based on 0 reviews     Review now
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              Updated guidance for trusted systematic reviews: a new edition of the Cochrane Handbook for Systematic Reviews of Interventions

              Miranda Cumpston, Tianjing Li, Matthew J L Page … (2019)
              Article 0 comments Cited 1571 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Journal
                Journal ID (nlm-ta): Front Cardiovasc Med
                Journal ID (iso-abbrev): Front Cardiovasc Med
                Journal ID (publisher-id): Front. Cardiovasc. Med.
                Title: Frontiers in Cardiovascular Medicine
                Publisher: Frontiers Media S.A.
                ISSN (Electronic): 2297-055X
                Publication date (Electronic): 20 June 2022
                Publication date Collection: 2022
                Volume: 9
                Electronic Location Identifier: 904250
                Affiliations
                [1] 1Department of Internal Medicine, The Second Affiliated Hospital of Hebei Medical University , Shijiazhuang, China
                [2] 2Department of Pathophysiology, College of Basic Medicine, Hebei Medical University , Shijiazhuang, China
                [3] 3Department of Pathophysiology, Hebei Key Laboratory of Critical Disease Mechanism and Intervention, Hebei Medical University , Shijiazhuang, China
                Author notes

                Edited by: Marat V. Ezhov, Ministry of Health of the Russian Federation, Russia

                Reviewed by: Tetsuro Miyazaki, Juntendo University Urayasu Hospital, Japan; Olga Germanova, Samara State Medical University, Russia

                *Correspondence: Xiaohui Xian hebmuxxh@ 123456hebmu.edu.cn

                This article was submitted to Atherosclerosis and Vascular Medicine, a section of the journal Frontiers in Cardiovascular Medicine

                †These authors have contributed equally to this work

                Article
                DOI: 10.3389/fcvm.2022.904250
                PMC ID: 9251200
                PubMed ID: 35795375
                SO-VID: 8a4f50d3-3341-4531-90f8-8cfcb85bbda5
                Copyright © Copyright © 2022 Gao, Zhang, Yan, Shi and Xian.
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                Date received : 29 March 2022
                Date accepted : 11 May 2022
                Page count
                Figures: 7, Tables: 2, Equations: 0, References: 71, Pages: 14, Words: 8327
                Categories
                Subject: Cardiovascular Medicine
                Subject: Systematic Review

                Keywords: ω-3 polyunsaturated fatty acids,coronary atherosclerosis,endothelial inflammations,cardiovascular imaging,cardiovascular therapy
                Data availability:
                Keywords: ω-3 polyunsaturated fatty acids, coronary atherosclerosis, endothelial inflammations, cardiovascular imaging, cardiovascular therapy

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