A prospective, randomized, and double‐blind trial on the effect of fish oil on the incidence of restenosis following ptca

Abstract

Restenosis after successful coronary angioplasty (PTCA) occurs in 25-35% of all procedures. To date, most pharmacologic strategies have failed to reduce the restenosis rate significantly. However, recent studies have suggested a potential benefit of dietary supplementation with omega-3 fatty acids (fish oil) on restenosis following PTCA. The benefit of omega-3 polyunsaturated fatty acids on the incidence of coronary artery restenosis following elective PTCA was assessed in 212 consecutive patients (41 female, 171 male). Following a successful angioplasty, 204 patients received a dietary supplementation with either nine capsules containing fish oil (3.15 g omega-3 fatty acids) or nine placebo capsules containing olive oil. Treatment was started immediately after PTCA and maintained over 4 mon. Compliance was assessed by analysis of lipid fatty acids prior to angioplasty and at 4 mon follow-up. The angiographically determined incidence of restenosis (stenosis diameter > 50%) was 31.2% per lesion in patients receiving fish oil and 33.7% in patients receiving olive oil. Gross progression of coronary artery disease in vessels not subjected to angioplasty was 17% and 16%, respectively. In conclusion, low dose fish oil supplementation begun on the day of a successful coronary angioplasty failed to demonstrate any effect on coronary artery restenosis.

The effect of LDL apheresis on progression of coronary artery disease in patients with familial hypercholesterolemia

“…Eight circumscribed stenoses showed regression of more than 10% and 11 progression of more than 10%. Intraobserver variability in ten repetitive measurements was 6.07%, 6.02%, 2.02%, and 6.48%, respectively, and within the range determined by other investigators [6][7][8]17]. Final panel judgement based on visual estirnation of overall atherosclerosis by the defined preconditions and stenosis quantification resulted in progression in 5 cases, questionable progression in 3, no change in 16, and undecided in one.…”

“…However, the intraobserver variability with the digital electronic caliper was low and in accordance with other investigators [7,17]. Diameter changes of less than 10% were excluded from evaluation because they may have been a result of spontaneous changes [13], and they were within the range of observer variability.…”

Effects of omega-3 fatty acids on cytokines and adhesion molecules

“…Studies on restenosis after percutaneous coronary angioplasty have been contradictory and, at the end, largely inconclusive [12][13][14][15][16][17][18][19][20][21][22][23], although issues of study design still leave the door open to the possibility that n-3 FA can have some efficacy on restenosis [24•]. Restenosis after percutaneous interventions is, however, the result of a mechanical injury to an already diseased vessel wall, and its relevance to native atherosclerosis is controversial.…”

Cardiovascular Effects of Omega-3 Free Fatty Acids.

“…17 clinical trials have been conducted [82][83][84][85][86][87][88][89][90][91][92][93][94][95][96][97]; the larger trials [91][92][93] failed to show a substantial effect of n-3 fatty acids on the coronary restenosis after angioplasty. A weak preventive effect, consistent with the stabilization of atherosclerotic plaques and a slower progression of the atherosclerotic lesions, seems to be demonstrated by other studies [96,97].…”