title: Omega-3 Fatty acids and mortality outcome in patients with and without type 2 diabetes after myocardial infarction: a retrospective, matched-cohort study.
abstract: BACKGROUND
  There are conflicting data regarding the benefits of omega-3 (n-3) fatty acids, most recently in patients with type 2 diabetes.
  
  
  OBJECTIVE
  Our goal was to evaluate the impact of licensed, highly purified n-3 fatty acids on all-cause mortality after myocardial infarction (MI).
  
  
  METHODS
  This was a retrospective, matched-cohort study using data from the General Practice Research Database. Patients initiating treatment with 1 g of n-3 fatty acids in the 90 days after first MI were identified and each matched to 4 nonexposed patients. Progression to death was compared using time-dependent Cox models to account for potential differences in exposure to other cardiovascular risk-modifying treatments.
  
  
  RESULTS
  A total of 2466 eligible subjects exposed to n-3 fatty acids were matched. The majority of patients had concurrent treatment with lipid-lowering therapies, antihypertensives, and antiplatelets after first MI, with subjects exposed to n-3 fatty acids having a greater likelihood of concurrent exposure. For those initiating n-3 fatty acids within 90 days of first MI, the adjusted hazard ratio (aHR) was 0.782 (95% CI, 0.641-0.995; P = 0.0159); for those initiating treatment within 14 days, the aHR was 0.680 (95% CI, 0.481-0.961; P = 0.0288). In patients with type 2 diabetes at baseline, the aHRs were 0.714 (95% CI, 0.454-1.124) and 0.597 (95% CI, 0.295-1.211) when initiation was within 90 and 14 days, respectively. Use of n-3 fatty acids resulted in a consistent survival benefit under a range of scenarios quantitatively consistent with the overall effect.
  
  
  CONCLUSIONS
  After MI, early treatment with licensed n-3 fatty acids was associated with improvement in all-cause mortality in patients with and without type 2 diabetes, against a background of contemporary cardiovascular risk-modifying treatments.
authors.affiliation: Department of Primary Care and Public Health, School of Medicine, Cardiff University, The Pharma Research Centre, Cardiff MediCentre, Cardiff, United Kingdom.
authors.forename: Chris D
authors.initials: CD
authors.lastname: Poole
authors.forename: Julian P
authors.initials: JP
authors.lastname: Halcox
authors.forename: Sara
authors.initials: S
authors.lastname: Jenkins-Jones
authors.forename: Emma S M
authors.initials: ES
authors.lastname: Carr
authors.forename: Mathias G
authors.initials: MG
authors.lastname: Schifflers
authors.forename: Kausik K
authors.initials: KK
authors.lastname: Ray
authors.forename: Craig J
authors.initials: CJ
authors.lastname: Currie
mesh_terms: D000368:Aged; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D003924:Diabetes Mellitus, Type 2 / Q000401:mortality*; D018450:Disease Progression; D043371:Fatty Acids, Omega-6 / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000401:mortality*; D011320:Primary Health Care; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D002317:Cardiovascular Agents; D043371:Fatty Acids, Omega-6