title: The impact of omega-3 polyunsaturated fatty acid supplementation on the incidence of cardiovascular events and complications in peripheral arterial disease: a systematic review and meta-analysis.
abstract: BACKGROUND
  Individuals with peripheral arterial disease are at higher risk for cardiovascular events than the general population. While supplementation with omega-3 polyunsaturated fatty acids (PUFA) has been shown to improve vascular function, it remains unclear if supplementation decreases serious clinical outcomes. We conducted a systematic review and meta-analysis to determine whether omega-3 PUFA supplementation reduces the incidence of cardiovascular events and complications in adults with peripheral arterial disease.
  
  
  METHODS
  We searched five electronic databases (MEDLINE, EMBASE, CENTRAL, Scopus and the International Clinical Trials Registry Platform) from inception to 6 December 2013 to identify randomized trials of omega-3 PUFA supplementation (from fish or plant oils) that lasted ≥12 weeks in adults with peripheral arterial disease. No language filters were applied. Data on trial design, population characteristics, and health outcomes were extracted. The primary outcome was major adverse cardiac events; secondary outcomes included myocardial infarction, cardiovascular death, stroke, angina, amputation, revascularization procedures, maximum and pain-free walking distance, adverse effects of the intervention, and quality of life. Trial quality was assessed using the Cochrane Risk of Bias tool.
  
  
  RESULTS
  Of 741 citations reviewed, we included five trials enrolling 396 individuals. All included trials were of unclear or high risk of bias. There was no evidence of a protective association of omega-3 PUFA supplementation against major adverse cardiac events (pooled risk ratio 0.73, 95% CI 0.22 to 2.41, I2 75%, 2 trials, 288 individuals) or other serious clinical outcomes. Adverse events and compliance were poorly reported.
  
  
  CONCLUSIONS
  Our results showed that insufficient evidence exists to suggest a beneficial effect of omega-3 PUFA supplementation in adults with peripheral arterial disease with regard to cardiovascular events and other serious clinical outcomes.
authors.forename: Jennifer E
authors.initials: JE
authors.lastname: Enns
authors.forename: Azadeh
authors.initials: A
authors.lastname: Yeganeh
authors.forename: Ryan
authors.initials: R
authors.lastname: Zarychanski
authors.forename: Ahmed M
authors.initials: AM
authors.lastname: Abou-Setta
authors.forename: Carol
authors.initials: C
authors.lastname: Friesen
authors.forename: Peter
authors.initials: P
authors.lastname: Zahradka
authors.affiliation: Department of Physiology, University of Manitoba, Winnipeg, Canada. ctaylor@sbrc.ca.
authors.forename: Carla G
authors.initials: CG
authors.lastname: Taylor
mesh_terms: D002561:Cerebrovascular Disorders / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D016009:Chi-Square Distribution; D019587:Dietary Supplements; D019317:Evidence-Based Medicine; D015525:Fatty Acids, Omega-3 / Q000627:therapeutic use*; D006331:Heart Diseases / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D006801:Humans; D015994:Incidence; D016017:Odds Ratio; D058729:Peripheral Arterial Disease / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D065840:Protective Factors; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D015525:Fatty Acids, Omega-3