No effect of n-3 fatty acids supplementation on NT-proBNP after myocardial infarction: The Alpha Omega Trial

Background heart failure is a major risk factor for cardiovascular mortality, for which n-3 fatty acids may have beneficial effects. We examined the effect of marine eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), and plant-derived alpha-linolenic acid (ALA) on N-Terminal-pro Brain Natriuretic Peptide (NT-proBNP), a biomarker of heart failure. Methods we randomly assigned 4837 post-myocardial infarction patients, aged 60-80 years (82% men), to margarines supplemented with a targeted additional intake of 400mg/day EPA and DHA, 2g/day ALA, EPA-DHA plus ALA, or placebo for 40 months. In a random selection of 639 patients, NT-proBNP was determined both at baseline and at the end of follow-up. NT-proBNP was log(e)-transformed and analysed by type of treatment using analysis of covariance adjusting for baseline NT-proNBP. Results patients consumed on average 19.8g margarine/day, providing an additional amount of 238mg/day EPA with 158mg/day DHA, 1.98g/day ALA, or both, in the active-treatment groups. In the placebo group, the geometric mean level NT-proBNP increased from 245ng/l (95%-confidence interval [CI]: 207-290) to 294ng/l (95%-CI: 244-352) after 40 months (p=0.001). NT-proBNP levels were not affected by ALA (+8% versus placebo; 95%-CI: -8% to +25%; p=0.34), EPA-DHA (+2% versus placebo; 95%-CI: -14% to +18%; p=0.78), nor EPA-DHA plus ALA (+9% versus placebo; 95%-CI: -8% to +25%; p=0.31) treatment. Conclusions supplementation with modest amounts of EPA-DHA, with or without ALA, did not have a significant effect on NT-proBNP levels in patients with a history of myocardial infarction.