Margarines supplemented with low dose n-3 fatty acids are not effective in secondary prevention

Abstract

This editorial refers to ‘Effects of n -3 fatty acids on major cardiovascular events in statin users and non-users with a history of myocardial infarction’†, by S.R.B.M. Eussen et al. , on page 1582 The concept of ‘functional foods’ is to add biologically active compounds to natural or processed foods to achieve a health benefit for the prevention or treatment of chronic diseases. The functional food industry continues to be an area of fast growth, in part because regulations and marketing strategies differ substantially from those of the pharmaceutical industry. Prospective randomized studies testing the impact of a functional food on cardiovascular events are rare. Therefore, Kromhout et al. are to be congratulated on their important Alpha Omega trial that randomized 4837 patients post-myocardial infarction to margarines supplemented with eicosapentaenoic acid (EPA) plus docosahexaenoic acid (DHA) (with a targeted additional daily intake of 400 mg) and/or plant-derived alpha-linolenic acid (ALA) (with a targeted additional daily intake of 2 g).1 In agreement with recent studies such as OMEGA2 and SU.FOL.OM3,3 Alpha Omega showed that margarines with low-dose n -3 polyunsaturated fatty acids ( n -3 FAs) do not prevent cardiovascular events in patients post-myocardial infarction. The result of the study is important, clear, and consistent: all three n -3 FA-supplemented margarines tested did not reduce the number of cardiovascular endpoints. Of the 4837 patients randomized in the Alpha Omega trial, only 2531 underwent a follow-up measurement of baseline characteristics due to budgetary constraints; the remaining individuals were followed by questionnaires. A total of 413 patients were classified as statin non-users. Eussen et al. have now performed a retrospective analysis on this small subgroup of ‘statin non-users’.4 The reasons for non-statin use were not assessed and non-statin use was not confirmed; the study did not record serial serum cholesterol concentrations. The …