© 2005 European Society of Cardiology
Left ventricular systolic dysfunction, total mortality, and sudden death in patients with myocardial infarction treated with n-3 polyunsaturated fatty acids
a Consorzio Mario Negri Sud Santa Maria Imbaro, Chieti, Italy
b Centro Studi ANMCO Firenze, Italy
c Department of Cardiovascular Disease Istituto di Ricerche Farmacologiche Mario Negri, Milano, Italy
d Ospedale Cervello, Palermo, Italy
e Ospedale Civile Presidio di Riabilitazione, Passirana di Rho, Milano, Italy
f IRCCS Policlinico San Matteo, Pavia, Italy
g Ospedale San Gerardo, Monza, Italy
h Ospedale S. Maria degli Angeli, Pordenone, Italy
* Corresponding author. Laboratory of Clinical Epidemiology of Cardiovascular Disease, Department of Clinical Pharmacology and Epidemiology, Consorzio Mario Negri Sud, Via Nazionale, 66030 Santa Maria Imbaro, Italy. Tel.: +39 0872 570252; fax: +39 0872 570206. E-mial address: marchioli{at}negrisud.it
 |
Abstract |
|---|
Background: Sudden death (SD) has a major impact on mortality (M) in patients with left ventricular systolic dysfunction (SyD). In GISSI-Prevenzione, treatment with n-3 polyunsaturated fatty acids (PUFA) reduced M and SD in post-MI patients, but their effect in patients with SyD is unknown.
Methods: 11,323 patients with prior MI and NYHA class
II were recruited. After excluding patients with no ejection fraction (EF) measurement (1684), and those with missing data (n=9), 9630 patients were available for analysis. Multivariate Cox regression adjusted models were fitted.
Results: Compared to patients with EF>50%, SyD patients had higher M (12.3% vs. 6.0%) and SD (3.4% vs. 1.4%) rates. PUFA reduced M similarly in patients with (RR 0.76 (0.60–0.96) P=0.02) and without SyD (RR 0.81 (0.59–1.10) P=0.17) (heterogeneity tests P=0.55). In contrast, the effect on SD was markedly asymmetrical: PUFA produced a marked reduction (RR 0.42 (0.26–0.67) P=0.0003) of risk in SyD patients whereas the effect was less evident (RR 0.89 (0.41–1.69) P=0.71) in patients with EF>50% (heterogeneity tests P=0.07). There was a significant increase in SD with worsening EF (P test for trend=0.02), the benefit on SD in patients with EF40% being 4-fold higher than in those with EF>50%.
Conclusions: Increasing SyD is associated with elevated risk of SD and with increasing benefit from PUFA. The effect of PUFA on SD reduction was greater in patients with SyD. Prospective trials testing the effect of PUFA in populations with SyD are required.
Key Words: Fatty acids • Unsaturated • Sudden death • Left ventricular systolic dysfunction
Received September 28, 2004; Accepted April 19, 2005
The names of GISSI-Prevenzione Investigators are reported in Lancet 1999; 354: 447–55. (14).
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  C. J. Lavie, R. V. Milani, M. R. Mehra, and H. O. Ventura Omega-3 polyunsaturated fatty acids and cardiovascular diseases. J. Am. Coll. Cardiol., August 11, 2009; 54(7): 585 - 594. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B M Yashodhara, S Umakanth, J M Pappachan, S K Bhat, R Kamath, and B H Choo Omega-3 fatty acids: a comprehensive review of their role in health and disease Postgrad. Med. J., February 1, 2009; 85(1000): 84 - 90. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. Giannuzzi, P. L. Temporelli, R. Marchioli, A. P. Maggioni, G. Balestroni, V. Ceci, C. Chieffo, M. Gattone, R. Griffo, C. Schweiger, et al. Global Secondary Prevention Strategies to Limit Event Recurrence After Myocardial Infarction: Results of the GOSPEL Study, a Multicenter, Randomized Controlled Trial From the Italian Cardiac Rehabilitation Network Arch Intern Med, November 10, 2008; 168(20): 2194 - 2204. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. J.A. Jenkins, A. R. Josse, P. Dorian, M. L. Burr, R. LaBelle Trangmar, C. W.C. Kendall, and S. C. Cunnane Heterogeneity in Randomized Controlled Trials of Long Chain (Fish) Omega-3 Fatty Acids in Restenosis, Secondary Prevention and Ventricular Arrhythmias J. Am. Coll. Nutr., June 1, 2008; 27(3): 367 - 378. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. H. Lee, J. H. O'Keefe, C. J. Lavie, R. Marchioli, and W. S. Harris Omega-3 Fatty Acids for Cardioprotection Mayo Clin. Proc., March 1, 2008; 83(3): 324 - 332. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. J.A. Jenkins MD PhD, A. R. Josse MSc, J. Beyene PhD, P. Dorian MD MSc, M. L. Burr MD DSc (Me, R. LaBelle BSc, C. W.C. Kendall PhD, and S. C. Cunnane PhD Fish-oil supplementation in patients with implantable cardioverter defibrillators: a meta-analysis Can. Med. Assoc. J., January 15, 2008; 178(2): 157 - 164. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. London, C. Albert, M. E. Anderson, W. R. Giles, D. R. Van Wagoner, E. Balk, G. E. Billman, M. Chung, W. Lands, A. Leaf, et al. Omega-3 Fatty Acids and Cardiac Arrhythmias: Prior Studies and Recommendations for Future Research: A Report from the National Heart, Lung, and Blood Institute and Office of Dietary Supplements Omega-3 Fatty Acids and Their Role in Cardiac Arrhythmogenesis Workshop Circulation, September 4, 2007; 116(10): e320 - e335. [Full Text] [PDF]
|
|
|
|
 |
|
 J. Gy. Papp, P. Pollesello, A. F. Varro, and A. S. Vegh Effect of Levosimendan and Milrinone on Regional Myocardial Ischemia/Reperfusion-Induced Arrhythmias in Dogs Journal of Cardiovascular Pharmacology and Therapeutics, June 1, 2006; 11(2): 129 - 135. [Abstract] [PDF]
|
|