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The utility of fish oil supplements (FOS) in coronary disease remains controversial. The characteristics of those who do and do not use FOS post-acute myocardial infarction (AMI) are unknown as are the associations of use with subsequent mortality.
The 24-site TRIUMPH study collected extensive information on 4340 AMI patients at admission and 1, 6, and 12 months post discharge. After excluding those using FOS at admission (n=651), who died in hospital (n=19), and lost to follow up (n=650), we analyzed 74 characteristics associated with starting FOS within 1 year of discharge. We found 25 differences between FOS users and non-users (p<0.001) and used 19 in hierarchical Cox regression models (including propensity matching) to assess the association of FOS use with 2-year mortality.
Within 1 year of AMI, 773 (26%) patients reported using FOS. FOS users were healthier in many ways (Table). Using propensity methods and adjusting for all of these factors, the adjusted HR for 2-year mortality was 0.52 (95% CI=0.417, 0.661; p<0.001).
In routine clinical practice, post-MI patients who initiate FOS are healthier and financially more secure than those who do not. Despite and after adjusting for these differences, initiation of FOS was associated with a 48% reduction in 2-year mortality. Although a beneficial effect of FOS itself cannot be ruled out, the likelihood of unmeasured confounding in these findings is substantial.
|Started FOS (n = 773)||Did not Start FOS (n = 2247)|
|White/Caucasian, n (%)||609 (78.8%)||1424 (63.7%)|
|Short of money at end of month, n (%)||109 (14.4%)||520 (23.6%)|
|Don't work for pay, n (%)||309 (40.4%)||1214 (54.5%)|
|Participated in Cardiac Rehab, n (%)||285 (44.6%)||388 (22.6%)|
|Has Insurance, n (%)||647 (85.7%)||1687 (76.6%)|
|History of Chronic Kidney Disease, n (%)||28 (3.6%)||171 (7.6%)|
|History of Chronic Heart Failure, n (%)||35 (4.5%)||195 (8.7%)|
|History of Stroke, n (%)||17 (2.2%)||129 (5.7%)|
|History of Prior MI, n (%)||105 (13.6%)||486 (21.6%)|
Poster Sessions, Expo North
Saturday, March 09, 2013, 10:00 a.m.-10:45 a.m.
Presentation Number: 1100-1
Session Title: Prevention: Risk Assessment and Prevention
Abstract Category: 24. Prevention: Clinical
- 2013 American College of Cardiology Foundation