The Role of Omega-3 Fatty Acids and Aspirin in the Prevention of Cardiovascular disease in Diabetes and Biochemical effectiveness of Omega-3 Fatty Acids and Aspirin in the ASCEND trial
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Abstract:
Background
The role of aspirin (100 mg daily) and omega-3 fatty acids (FA) (1 g daily) for
primary prevention of cardiovascular disease in diabetes is being
investigated in the 2x2 factorial design ASCEND trial. To support the
interpretation of the trial’s efficacy findings, it is important to compare selfreported
compliance by participants with measures of the biochemical effects
of each intervention. The previous data on the effect of supplementation with
omega-3 FA on coronary heart disease is uncertain.
Methods
The ASCEND trial randomly allocated 15480 people with diabetes (94% type
2 DM) who do not already have diagnosed occlusive arterial disease to
receive aspirin or placebo and to omega-3 FA or placebo. Blood and urine
samples were collected by mail at baseline and after 3 years follow-up. The
effectiveness of aspirin to suppress urinary thromboxane B2 (UTxB2), a
marker of platelet activity, and, of omega-3 FA supplements to increase red
cell membrane omega-3 index were assessed. A systematic review of
previous trials of omega-3 FA was conducted to summarize the prior
evidence for the effects of omega-3 FA supplements on major vascular
events (MVEs).
Results
Aspirin reduced UTxB2 levels by 67% (63-70%) (p <0.0001) compared with
placebo, from 3453 pg/mg (95% CI 3061-3895) at baseline to 1190 pg/mg
(1100-1287) on those allocated to aspirin during the trial. During follow-up,
the omega-3 index increased by 33% (95% CI 26%-39%) in those allocated
omega-3 FA compared to placebo (p<0.0001). The meta-analysis of previous
studies of omega-3 FA showed no effect on MVEs (HR 0.97; [0.93-1.01])
overall or in any pre-specified sub-groups.
Conclusions
Low dose aspirin and omega-3 FA are biochemically effective at reducing
UTxB2 and increasing the omega-3 index, respectively. Previous trials show
that supplementation with omega-3 FA had no significant effect on MVEs.
The results of the ASCEND trial, assessing the effects of both aspirin and
omega-3 FA on MVEs, will be available in 2018.
Authors
Aung, TheingiCollections
- Theses [4137]