Marine-derived n-3 fatty acids therapy for stroke (Review)

Celia Gabriela Alvarez Campano (Corresponding Author), Mary Macleod, Lorna Sharman Aucott, Frank Thies

Research output: Contribution to journalArticle

Abstract

Background Currently, with stroke burden increasing, there is a need to explore therapeutic options that ameliorate the acute insult. There is substantial evidence of a neuroprotective effect of marine-derived n-3 polyunsaturated fatty acids (PUFAs) in experimental stroke, leading to a better functional outcome. Objectives To assess the effects of administration of marine-derived n-3 PUFAs on functional outcomes and dependence in people with stroke. Our secondary outcomes were vascular-related death, recurrent events, incidence of other type of stroke, adverse events, quality of life, and mood. Search methods We searched theCochrane StrokeGroup trials register (6August 2018), theCochraneCentral Register ofControlledTrials (CENTRAL; Issue 1, January 2019), MEDLINE Ovid (from 1948 to 6 August 2018), Embase Ovid (from 1980 to 6 August 2018), CINAHL EBSCO (Cumulative Index to Nursing and Allied Health Literature; from 1982 to 6 August 2018), Science Citation Index Expanded Web of Science (SCI-EXPANDED), Conference Proceedings Citation Index-Science - Web of Science (CPCI-S), and BIOSIS Citation Index.We also searched ongoing trial registers, reference lists, relevant systematic reviews, and used the Science Citation Index Reference Search. Selection criteria We included randomised controlled trials (RCTs) comparing marine-derived n-3 PUFAs to placebo or open control (no placebo) in people with a history of stroke or transient ischaemic attack (TIA), or both. Data collection and analysis At least two review authors independently selected trials for inclusion, extracted data, assessed risk of bias, and used the GRADE approach to assess the quality of the body of evidence. We contacted study authors for clarification and additional information on stroke/TIA participants. We conducted random-effects meta-analysis or narrative synthesis, as appropriate. The primary outcome was efficacy (functional outcome) assessed using a validated scale e.g. Glasgow Outcome Scale Extended (GOSE) dichotomised into poor or good clinical outcome, Barthel Index (higher score is better; scale from 0 to 100) or RivermeadMobility Index (higher score is better; scale from 0 to 15). Marine-derived n-3 fatty acids therapy for stroke (Review) 1 Copyright © 2019 The Cochrane Collaboration. Published by JohnWiley & Sons, Ltd. For Preview Only Main results We included 29 RCTs; nine of them provided outcome data (3339 participants). Only one study included participants in the acute phase of stroke (haemorrhagic). Doses of marine-derived n-3 PUFAs ranged from 400 mg/day to 3300 mg/day. Risk of bias was generally low or unclear in most trials, with a higher risk of bias in smaller studies. We assessed results separately for short (up to three months) and longer (more than three months) follow-up studies. Short follow-up (up to three months) Functional outcome was reported in only one pilot study as poor clinical outcome assessed with GOSE (risk ratio (RR) 0.78, 95% confidence interval (CI) 0.36 to 1.68; 40 participants; very low quality evidence). Mood (assessed with GHQ-30, lower score better), was reported by only one study and favoured control (mean difference (MD) 1.41, 95% CI 0.07 to 2.75; 102 participants; low-quality evidence). We found no evidence of an effect of the intervention for the remainder of the secondary outcomes: vascular-related death (two studies, not pooled due to differences in population, RR 0.33, 95% CI 0.01 to 8.00, and RR 0.33, 95% CI 0.01 to 7.72; 142 participants; low-quality evidence); recurrent events (RR 0.41, 95% CI 0.02 to 8.84; 18 participants; very low quality evidence); incidence of other type of stroke (two studies, not pooled due to different type of index stroke, RR 6.11, 95% CI 0.33 to 111.71, and RR 0.63, 95% CI 0.25 to 1.58; 58 participants; very low quality evidence); and quality of life (physical component mean difference (MD) −2.31, 95% CI −4.81 to 0.19, and mental component MD −2.16, 95% CI −5.91 to 1.59; one study; 102 participants; low-quality evidence). Adverse events were reported by two studies (57 participants; very low quality evidence), one trial reporting extracranial haemorrhage (RR 0.25, 95% CI 0.04 to 1.73) and the other one reporting bleeding complications (RR 0.32, 95% CI 0.01 to 7.35). Longer follow-up (more than three months) One small trial assessed functional outcome with both Barthel Index (MD 7.09, 95% CI −5.16 to 19.34) for activities of daily living, and RivermeadMobility Index (MD 1.30, 95%CI −1.31 to 3.91) for mobility (52 participants; very low quality evidence).We carried out meta-analysis for vascular-related death (RR 1.02, 95% CI 0.78 to 1.35; five studies; 2237 participants; low-quality evidence) and fatal recurrent events (RR 0.69, 95% CI 0.31 to 1.55; three studies; 1819 participants; low-quality evidence). We found no evidence of an effect of the intervention for mood (MD 1.00, 95% CI −2.07 to 4.07; one study; 14 participants; lowquality evidence). Incidence of other type of stroke and quality of life were not reported. Adverse events (all combined) were reported by only one study (RR 0.94, 95%CI 0.56 to 1.58; 1455 participants; low-quality evidence). Authors’ conclusions We are very uncertain of the effect of marine-derived n-3 PUFAs therapy on functional outcomes and dependence after stroke as there is insufficient high-quality evidence. More well-designed RCTs are needed, specifically in acute stroke, to determine the efficacy and safety of the intervention. Studies assessing functionality might consider starting the intervention as early as possible after the event, as well as using standardised clinically-relevant measures for functional outcomes, such as the modified Rankin Scale. Optimal doses remain to be determined; delivery forms (type of lipid carriers) and mode of administration (ingestion or injection) also need further consideration.
Original languageEnglish
Article numberCD012815
JournalCochrane Database of Systematic Reviews
Volume2019
Issue number6
DOIs
Publication statusPublished - 26 Jun 2019

Fingerprint

Omega-3 Fatty Acids
Stroke
Confidence Intervals
Odds Ratio
Therapeutics
Glasgow Outcome Scale
Blood Vessels
Randomized Controlled Trials
Transient Ischemic Attack
Quality of Life
Meta-Analysis
Incidence
Placebos
Hemorrhage
Neuroprotective Agents
Activities of Daily Living
MEDLINE

Keywords

  • n-3 PUFA
  • stroke
  • INTIMA-MEDIA THICKNESS
  • CHRONIC HEART-FAILURE
  • FISH-OIL SUPPLEMENTATION
  • BASAL INSULIN GLARGINE
  • HIGH TRIGLYCERIDE LEVELS
  • POSTMYOCARDIAL INFARCTION PATIENTS
  • ACUTE MYOCARDIAL-INFARCTION
  • PLACEBO-CONTROLLED TRIAL
  • HIGHLY PURIFIED OMEGA-3-FATTY-ACIDS
  • CORONARY-ARTERY-DISEASE

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Marine-derived n-3 fatty acids therapy for stroke (Review). / Alvarez Campano, Celia Gabriela (Corresponding Author); Macleod, Mary; Aucott, Lorna Sharman; Thies, Frank.

In: Cochrane Database of Systematic Reviews, Vol. 2019, No. 6, CD012815, 26.06.2019.

Research output: Contribution to journalArticle

@article{a7942534f08743df83bb5101758787d8,
title = "Marine-derived n-3 fatty acids therapy for stroke (Review)",
abstract = "Background Currently, with stroke burden increasing, there is a need to explore therapeutic options that ameliorate the acute insult. There is substantial evidence of a neuroprotective effect of marine-derived n-3 polyunsaturated fatty acids (PUFAs) in experimental stroke, leading to a better functional outcome. Objectives To assess the effects of administration of marine-derived n-3 PUFAs on functional outcomes and dependence in people with stroke. Our secondary outcomes were vascular-related death, recurrent events, incidence of other type of stroke, adverse events, quality of life, and mood. Search methods We searched theCochrane StrokeGroup trials register (6August 2018), theCochraneCentral Register ofControlledTrials (CENTRAL; Issue 1, January 2019), MEDLINE Ovid (from 1948 to 6 August 2018), Embase Ovid (from 1980 to 6 August 2018), CINAHL EBSCO (Cumulative Index to Nursing and Allied Health Literature; from 1982 to 6 August 2018), Science Citation Index Expanded Web of Science (SCI-EXPANDED), Conference Proceedings Citation Index-Science - Web of Science (CPCI-S), and BIOSIS Citation Index.We also searched ongoing trial registers, reference lists, relevant systematic reviews, and used the Science Citation Index Reference Search. Selection criteria We included randomised controlled trials (RCTs) comparing marine-derived n-3 PUFAs to placebo or open control (no placebo) in people with a history of stroke or transient ischaemic attack (TIA), or both. Data collection and analysis At least two review authors independently selected trials for inclusion, extracted data, assessed risk of bias, and used the GRADE approach to assess the quality of the body of evidence. We contacted study authors for clarification and additional information on stroke/TIA participants. We conducted random-effects meta-analysis or narrative synthesis, as appropriate. The primary outcome was efficacy (functional outcome) assessed using a validated scale e.g. Glasgow Outcome Scale Extended (GOSE) dichotomised into poor or good clinical outcome, Barthel Index (higher score is better; scale from 0 to 100) or RivermeadMobility Index (higher score is better; scale from 0 to 15). Marine-derived n-3 fatty acids therapy for stroke (Review) 1 Copyright {\circledC} 2019 The Cochrane Collaboration. Published by JohnWiley & Sons, Ltd. For Preview Only Main results We included 29 RCTs; nine of them provided outcome data (3339 participants). Only one study included participants in the acute phase of stroke (haemorrhagic). Doses of marine-derived n-3 PUFAs ranged from 400 mg/day to 3300 mg/day. Risk of bias was generally low or unclear in most trials, with a higher risk of bias in smaller studies. We assessed results separately for short (up to three months) and longer (more than three months) follow-up studies. Short follow-up (up to three months) Functional outcome was reported in only one pilot study as poor clinical outcome assessed with GOSE (risk ratio (RR) 0.78, 95{\%} confidence interval (CI) 0.36 to 1.68; 40 participants; very low quality evidence). Mood (assessed with GHQ-30, lower score better), was reported by only one study and favoured control (mean difference (MD) 1.41, 95{\%} CI 0.07 to 2.75; 102 participants; low-quality evidence). We found no evidence of an effect of the intervention for the remainder of the secondary outcomes: vascular-related death (two studies, not pooled due to differences in population, RR 0.33, 95{\%} CI 0.01 to 8.00, and RR 0.33, 95{\%} CI 0.01 to 7.72; 142 participants; low-quality evidence); recurrent events (RR 0.41, 95{\%} CI 0.02 to 8.84; 18 participants; very low quality evidence); incidence of other type of stroke (two studies, not pooled due to different type of index stroke, RR 6.11, 95{\%} CI 0.33 to 111.71, and RR 0.63, 95{\%} CI 0.25 to 1.58; 58 participants; very low quality evidence); and quality of life (physical component mean difference (MD) −2.31, 95{\%} CI −4.81 to 0.19, and mental component MD −2.16, 95{\%} CI −5.91 to 1.59; one study; 102 participants; low-quality evidence). Adverse events were reported by two studies (57 participants; very low quality evidence), one trial reporting extracranial haemorrhage (RR 0.25, 95{\%} CI 0.04 to 1.73) and the other one reporting bleeding complications (RR 0.32, 95{\%} CI 0.01 to 7.35). Longer follow-up (more than three months) One small trial assessed functional outcome with both Barthel Index (MD 7.09, 95{\%} CI −5.16 to 19.34) for activities of daily living, and RivermeadMobility Index (MD 1.30, 95{\%}CI −1.31 to 3.91) for mobility (52 participants; very low quality evidence).We carried out meta-analysis for vascular-related death (RR 1.02, 95{\%} CI 0.78 to 1.35; five studies; 2237 participants; low-quality evidence) and fatal recurrent events (RR 0.69, 95{\%} CI 0.31 to 1.55; three studies; 1819 participants; low-quality evidence). We found no evidence of an effect of the intervention for mood (MD 1.00, 95{\%} CI −2.07 to 4.07; one study; 14 participants; lowquality evidence). Incidence of other type of stroke and quality of life were not reported. Adverse events (all combined) were reported by only one study (RR 0.94, 95{\%}CI 0.56 to 1.58; 1455 participants; low-quality evidence). Authors’ conclusions We are very uncertain of the effect of marine-derived n-3 PUFAs therapy on functional outcomes and dependence after stroke as there is insufficient high-quality evidence. More well-designed RCTs are needed, specifically in acute stroke, to determine the efficacy and safety of the intervention. Studies assessing functionality might consider starting the intervention as early as possible after the event, as well as using standardised clinically-relevant measures for functional outcomes, such as the modified Rankin Scale. Optimal doses remain to be determined; delivery forms (type of lipid carriers) and mode of administration (ingestion or injection) also need further consideration.",
keywords = "n-3 PUFA, stroke, INTIMA-MEDIA THICKNESS, CHRONIC HEART-FAILURE, FISH-OIL SUPPLEMENTATION, BASAL INSULIN GLARGINE, HIGH TRIGLYCERIDE LEVELS, POSTMYOCARDIAL INFARCTION PATIENTS, ACUTE MYOCARDIAL-INFARCTION, PLACEBO-CONTROLLED TRIAL, HIGHLY PURIFIED OMEGA-3-FATTY-ACIDS, CORONARY-ARTERY-DISEASE",
author = "{Alvarez Campano}, {Celia Gabriela} and Mary Macleod and Aucott, {Lorna Sharman} and Frank Thies",
year = "2019",
month = "6",
day = "26",
doi = "10.1002/14651858.CD012815.pub2",
language = "English",
volume = "2019",
journal = "Cochrane Database of Systematic Reviews",
issn = "1469-493X",
publisher = "Wiley",
number = "6",

}

TY - JOUR

T1 - Marine-derived n-3 fatty acids therapy for stroke (Review)

AU - Alvarez Campano, Celia Gabriela

AU - Macleod, Mary

AU - Aucott, Lorna Sharman

AU - Thies, Frank

PY - 2019/6/26

Y1 - 2019/6/26

N2 - Background Currently, with stroke burden increasing, there is a need to explore therapeutic options that ameliorate the acute insult. There is substantial evidence of a neuroprotective effect of marine-derived n-3 polyunsaturated fatty acids (PUFAs) in experimental stroke, leading to a better functional outcome. Objectives To assess the effects of administration of marine-derived n-3 PUFAs on functional outcomes and dependence in people with stroke. Our secondary outcomes were vascular-related death, recurrent events, incidence of other type of stroke, adverse events, quality of life, and mood. Search methods We searched theCochrane StrokeGroup trials register (6August 2018), theCochraneCentral Register ofControlledTrials (CENTRAL; Issue 1, January 2019), MEDLINE Ovid (from 1948 to 6 August 2018), Embase Ovid (from 1980 to 6 August 2018), CINAHL EBSCO (Cumulative Index to Nursing and Allied Health Literature; from 1982 to 6 August 2018), Science Citation Index Expanded Web of Science (SCI-EXPANDED), Conference Proceedings Citation Index-Science - Web of Science (CPCI-S), and BIOSIS Citation Index.We also searched ongoing trial registers, reference lists, relevant systematic reviews, and used the Science Citation Index Reference Search. Selection criteria We included randomised controlled trials (RCTs) comparing marine-derived n-3 PUFAs to placebo or open control (no placebo) in people with a history of stroke or transient ischaemic attack (TIA), or both. Data collection and analysis At least two review authors independently selected trials for inclusion, extracted data, assessed risk of bias, and used the GRADE approach to assess the quality of the body of evidence. We contacted study authors for clarification and additional information on stroke/TIA participants. We conducted random-effects meta-analysis or narrative synthesis, as appropriate. The primary outcome was efficacy (functional outcome) assessed using a validated scale e.g. Glasgow Outcome Scale Extended (GOSE) dichotomised into poor or good clinical outcome, Barthel Index (higher score is better; scale from 0 to 100) or RivermeadMobility Index (higher score is better; scale from 0 to 15). Marine-derived n-3 fatty acids therapy for stroke (Review) 1 Copyright © 2019 The Cochrane Collaboration. Published by JohnWiley & Sons, Ltd. For Preview Only Main results We included 29 RCTs; nine of them provided outcome data (3339 participants). Only one study included participants in the acute phase of stroke (haemorrhagic). Doses of marine-derived n-3 PUFAs ranged from 400 mg/day to 3300 mg/day. Risk of bias was generally low or unclear in most trials, with a higher risk of bias in smaller studies. We assessed results separately for short (up to three months) and longer (more than three months) follow-up studies. Short follow-up (up to three months) Functional outcome was reported in only one pilot study as poor clinical outcome assessed with GOSE (risk ratio (RR) 0.78, 95% confidence interval (CI) 0.36 to 1.68; 40 participants; very low quality evidence). Mood (assessed with GHQ-30, lower score better), was reported by only one study and favoured control (mean difference (MD) 1.41, 95% CI 0.07 to 2.75; 102 participants; low-quality evidence). We found no evidence of an effect of the intervention for the remainder of the secondary outcomes: vascular-related death (two studies, not pooled due to differences in population, RR 0.33, 95% CI 0.01 to 8.00, and RR 0.33, 95% CI 0.01 to 7.72; 142 participants; low-quality evidence); recurrent events (RR 0.41, 95% CI 0.02 to 8.84; 18 participants; very low quality evidence); incidence of other type of stroke (two studies, not pooled due to different type of index stroke, RR 6.11, 95% CI 0.33 to 111.71, and RR 0.63, 95% CI 0.25 to 1.58; 58 participants; very low quality evidence); and quality of life (physical component mean difference (MD) −2.31, 95% CI −4.81 to 0.19, and mental component MD −2.16, 95% CI −5.91 to 1.59; one study; 102 participants; low-quality evidence). Adverse events were reported by two studies (57 participants; very low quality evidence), one trial reporting extracranial haemorrhage (RR 0.25, 95% CI 0.04 to 1.73) and the other one reporting bleeding complications (RR 0.32, 95% CI 0.01 to 7.35). Longer follow-up (more than three months) One small trial assessed functional outcome with both Barthel Index (MD 7.09, 95% CI −5.16 to 19.34) for activities of daily living, and RivermeadMobility Index (MD 1.30, 95%CI −1.31 to 3.91) for mobility (52 participants; very low quality evidence).We carried out meta-analysis for vascular-related death (RR 1.02, 95% CI 0.78 to 1.35; five studies; 2237 participants; low-quality evidence) and fatal recurrent events (RR 0.69, 95% CI 0.31 to 1.55; three studies; 1819 participants; low-quality evidence). We found no evidence of an effect of the intervention for mood (MD 1.00, 95% CI −2.07 to 4.07; one study; 14 participants; lowquality evidence). Incidence of other type of stroke and quality of life were not reported. Adverse events (all combined) were reported by only one study (RR 0.94, 95%CI 0.56 to 1.58; 1455 participants; low-quality evidence). Authors’ conclusions We are very uncertain of the effect of marine-derived n-3 PUFAs therapy on functional outcomes and dependence after stroke as there is insufficient high-quality evidence. More well-designed RCTs are needed, specifically in acute stroke, to determine the efficacy and safety of the intervention. Studies assessing functionality might consider starting the intervention as early as possible after the event, as well as using standardised clinically-relevant measures for functional outcomes, such as the modified Rankin Scale. Optimal doses remain to be determined; delivery forms (type of lipid carriers) and mode of administration (ingestion or injection) also need further consideration.

AB - Background Currently, with stroke burden increasing, there is a need to explore therapeutic options that ameliorate the acute insult. There is substantial evidence of a neuroprotective effect of marine-derived n-3 polyunsaturated fatty acids (PUFAs) in experimental stroke, leading to a better functional outcome. Objectives To assess the effects of administration of marine-derived n-3 PUFAs on functional outcomes and dependence in people with stroke. Our secondary outcomes were vascular-related death, recurrent events, incidence of other type of stroke, adverse events, quality of life, and mood. Search methods We searched theCochrane StrokeGroup trials register (6August 2018), theCochraneCentral Register ofControlledTrials (CENTRAL; Issue 1, January 2019), MEDLINE Ovid (from 1948 to 6 August 2018), Embase Ovid (from 1980 to 6 August 2018), CINAHL EBSCO (Cumulative Index to Nursing and Allied Health Literature; from 1982 to 6 August 2018), Science Citation Index Expanded Web of Science (SCI-EXPANDED), Conference Proceedings Citation Index-Science - Web of Science (CPCI-S), and BIOSIS Citation Index.We also searched ongoing trial registers, reference lists, relevant systematic reviews, and used the Science Citation Index Reference Search. Selection criteria We included randomised controlled trials (RCTs) comparing marine-derived n-3 PUFAs to placebo or open control (no placebo) in people with a history of stroke or transient ischaemic attack (TIA), or both. Data collection and analysis At least two review authors independently selected trials for inclusion, extracted data, assessed risk of bias, and used the GRADE approach to assess the quality of the body of evidence. We contacted study authors for clarification and additional information on stroke/TIA participants. We conducted random-effects meta-analysis or narrative synthesis, as appropriate. The primary outcome was efficacy (functional outcome) assessed using a validated scale e.g. Glasgow Outcome Scale Extended (GOSE) dichotomised into poor or good clinical outcome, Barthel Index (higher score is better; scale from 0 to 100) or RivermeadMobility Index (higher score is better; scale from 0 to 15). Marine-derived n-3 fatty acids therapy for stroke (Review) 1 Copyright © 2019 The Cochrane Collaboration. Published by JohnWiley & Sons, Ltd. For Preview Only Main results We included 29 RCTs; nine of them provided outcome data (3339 participants). Only one study included participants in the acute phase of stroke (haemorrhagic). Doses of marine-derived n-3 PUFAs ranged from 400 mg/day to 3300 mg/day. Risk of bias was generally low or unclear in most trials, with a higher risk of bias in smaller studies. We assessed results separately for short (up to three months) and longer (more than three months) follow-up studies. Short follow-up (up to three months) Functional outcome was reported in only one pilot study as poor clinical outcome assessed with GOSE (risk ratio (RR) 0.78, 95% confidence interval (CI) 0.36 to 1.68; 40 participants; very low quality evidence). Mood (assessed with GHQ-30, lower score better), was reported by only one study and favoured control (mean difference (MD) 1.41, 95% CI 0.07 to 2.75; 102 participants; low-quality evidence). We found no evidence of an effect of the intervention for the remainder of the secondary outcomes: vascular-related death (two studies, not pooled due to differences in population, RR 0.33, 95% CI 0.01 to 8.00, and RR 0.33, 95% CI 0.01 to 7.72; 142 participants; low-quality evidence); recurrent events (RR 0.41, 95% CI 0.02 to 8.84; 18 participants; very low quality evidence); incidence of other type of stroke (two studies, not pooled due to different type of index stroke, RR 6.11, 95% CI 0.33 to 111.71, and RR 0.63, 95% CI 0.25 to 1.58; 58 participants; very low quality evidence); and quality of life (physical component mean difference (MD) −2.31, 95% CI −4.81 to 0.19, and mental component MD −2.16, 95% CI −5.91 to 1.59; one study; 102 participants; low-quality evidence). Adverse events were reported by two studies (57 participants; very low quality evidence), one trial reporting extracranial haemorrhage (RR 0.25, 95% CI 0.04 to 1.73) and the other one reporting bleeding complications (RR 0.32, 95% CI 0.01 to 7.35). Longer follow-up (more than three months) One small trial assessed functional outcome with both Barthel Index (MD 7.09, 95% CI −5.16 to 19.34) for activities of daily living, and RivermeadMobility Index (MD 1.30, 95%CI −1.31 to 3.91) for mobility (52 participants; very low quality evidence).We carried out meta-analysis for vascular-related death (RR 1.02, 95% CI 0.78 to 1.35; five studies; 2237 participants; low-quality evidence) and fatal recurrent events (RR 0.69, 95% CI 0.31 to 1.55; three studies; 1819 participants; low-quality evidence). We found no evidence of an effect of the intervention for mood (MD 1.00, 95% CI −2.07 to 4.07; one study; 14 participants; lowquality evidence). Incidence of other type of stroke and quality of life were not reported. Adverse events (all combined) were reported by only one study (RR 0.94, 95%CI 0.56 to 1.58; 1455 participants; low-quality evidence). Authors’ conclusions We are very uncertain of the effect of marine-derived n-3 PUFAs therapy on functional outcomes and dependence after stroke as there is insufficient high-quality evidence. More well-designed RCTs are needed, specifically in acute stroke, to determine the efficacy and safety of the intervention. Studies assessing functionality might consider starting the intervention as early as possible after the event, as well as using standardised clinically-relevant measures for functional outcomes, such as the modified Rankin Scale. Optimal doses remain to be determined; delivery forms (type of lipid carriers) and mode of administration (ingestion or injection) also need further consideration.

KW - n-3 PUFA

KW - stroke

KW - INTIMA-MEDIA THICKNESS

KW - CHRONIC HEART-FAILURE

KW - FISH-OIL SUPPLEMENTATION

KW - BASAL INSULIN GLARGINE

KW - HIGH TRIGLYCERIDE LEVELS

KW - POSTMYOCARDIAL INFARCTION PATIENTS

KW - ACUTE MYOCARDIAL-INFARCTION

KW - PLACEBO-CONTROLLED TRIAL

KW - HIGHLY PURIFIED OMEGA-3-FATTY-ACIDS

KW - CORONARY-ARTERY-DISEASE

UR - http://www.mendeley.com/research/marinederived-n3-fatty-acids-therapy-stroke-1

UR - http://www.scopus.com/inward/record.url?scp=85068137926&partnerID=8YFLogxK

U2 - 10.1002/14651858.CD012815.pub2

DO - 10.1002/14651858.CD012815.pub2

M3 - Article

VL - 2019

JO - Cochrane Database of Systematic Reviews

JF - Cochrane Database of Systematic Reviews

SN - 1469-493X

IS - 6

M1 - CD012815

ER -