Stroke recovery: jury is still out on benefits of fish oil

Takeaway

• Cochrane review finds high uncertainty about benefits of fish oil on functional outcomes after stroke or transient ischemic attack (TIA).

Why this matters

• Increasing burden of stroke.

Key results

• Short follow-up (≤3 months):
  • Poor functional outcome on Glasgow Outcome Scale Extended (risk ratio [RR], 0.78; 95% CI, 0.36-1.68).
  • Mood on 30-item General Health Questionnaire favored control (mean difference [MD], 1.41; 95% CI, 0.07-2.75).
  • No significant effect:
    • Vascular-related death.
    • Recurrent events.
    • Incidence of other type of stroke.
    • QoL.
  • Adverse events:
    • Extracranial hemorrhage (RR, 0.25; 95% CI, 0.04-1.73).
    • Bleeding complications (RR, 0.32; 95% CI, 0.01-7.35).
• Longer follow-up (>3 months):
  • Functional outcome:
    • Barthel Index (MD, 7.09; 95% CI, –5.16 to 19.34).
    • Rivermead Mobility Index (MD, 1.30; 95% CI, –1.31 to 3.91).
  • • Vascular-related death (RR, 1.02; 95% CI, 0.78-1.35).
    • Fatal recurrent events (RR, 0.69; 95% CI, 0.31-1.55).
  • No effect on mood.
  • Other types of stroke, QoL not reported.
  • Adverse events (RR, 0.94; 95% CI, 0.56-1.58).

Study design

• 29 randomized controlled trials, marine-derived omega-3 polyunsaturated fatty acids (fish oil, fish intake, or supplements) vs placebo/open control after stroke, TIA, both.
• Outcomes for 9 trials, 3339 participants.
• Main outcome: functional outcome.
• Funding: University of Aberdeen; others.

Limitations

• Limited high-quality evidence.
• Single trial in acute setting.