Table 3.
Subgroup estimation of the effects of fish oil supplementation on TNF-α and IL-6 in patients with CHF
| |
TNF-α |
IL-6 |
||||
|---|---|---|---|---|---|---|
| Subgroup | Study arms (n)/patients (n) | SMD [95% CI] | p※ | Study arms (n)/patients (n) | SMD (95% CI) | p※ |
|
Age |
|
|
|
|
|
|
| ≤ 60 years |
3/57 |
-0.47 [-1.22, 0.27] |
|
2/43 |
-0.80 [-1.45, -0.15] |
|
| > 60 years |
4/285 |
-0.68 [-1.28, -0.08] |
0.67 |
4/285 |
-0.81 [-1.72, 0.10] |
0.99 |
|
Gender (male) |
|
|
|
|
|
|
| ≤ 90% |
4/244 |
-0.76 [-1.48, -0.03] |
|
3/230 |
-1.02 [-1.77, -0.28] |
|
| > 90% |
3/98 |
-0.44 [-0.87, -0.02] |
0.46 |
3/98 |
-0.60 [-1.92, 0.72] |
0.58 |
|
Ischemic CHF |
|
|
|
|
|
|
| Not excluded |
3/125 |
-0.42 [-0.94, 0.09] |
|
2/111 |
-0.05 [-1.17, 1.07] |
|
| Excluded |
4/217 |
-0.71 [-1.34, -0.07] |
0.50 |
4/217 |
-1.33 [-1.74, -0.92] |
0.06 |
|
Baseline NYHA (class IV) |
|
|
|
|
|
|
| Not included |
3/249 |
-0.85 [-1.51, -0.18] |
|
3/249 |
-1.23 [-1.93, -0.54] |
|
| Included |
3/57 |
-0.47 [-1.22, 0.27] |
0.47 |
2/43 |
-0.80 [-1.45, -0.15] |
0.37 |
|
Baseline LVEF |
|
|
|
|
|
|
| ≤ 30% |
3/57 |
-0.47 [-1.22, 0.27] |
|
2/43 |
-0.80 [-1.45, -0.15] |
|
| > 30% |
3/249 |
-0.85 [-1.51, -0.18] |
0.47 |
3/249 |
-1.23 [-1.93, -0.54] |
0.37 |
|
Baseline TNF-α |
|
|
|
|
|
|
| ≤ 10 pg/ml |
4/93 |
-0.33 [-0.82, 0.17] |
|
— |
— |
|
| > 10 pg/ml |
3/249 |
-0.85 [-1.51, -0.18] |
0.22 |
— |
— |
— |
|
Baseline IL-6 |
|
|
|
|
|
|
| ≤ 5 pg/ml |
— |
— |
|
3/79 |
-0.31 [-1.27, 0.65] |
|
| > 5 pg/ml |
— |
— |
— |
3/249 |
-1.23 [-1.93, -0.54] |
0.13 |
|
ACEI/ARB |
|
|
|
|
|
|
| Not all used |
1/14 |
-1.41 [-2.62, -0.19] |
|
0/0 |
— |
|
| All used |
5/292 |
-0.62 [-1.17, -0.08] |
0.25 |
5/292 |
-1.10 [-1.60, -0.60] |
— |
|
β-blockers |
|
|
|
|
|
|
| Not all used |
3/125 |
-0.42 [-0.94, 0.09] |
|
2/111 |
-0.05 [-1.17, 1.07] |
|
| All used |
4/217 |
-0.71 [-1.34, -0.07] |
0.50 |
4/217 |
-1.33 [-1.74, -0.92] |
0.06 |
|
EPA + DHA |
|
|
|
|
|
|
| ≤ 1000 mg/d |
3/133 |
-0.23 [-0.57, 0.11] |
|
3/133 |
-0.26 [-1.06, 0.54] |
|
| > 1000 mg/d |
4/209 |
-1.01 [-1.50, -0.53] |
0.01 |
3/195 |
-1.47 [-1.84, -1.11] |
0.007 |
|
EPA |
|
|
|
|
|
|
| ≤ 800 mg/d |
4/266 |
-0.51 [-1.20, 0.19] |
|
4/266 |
-0.62 [-1.54, 0.29] |
|
| > 800 mg/d |
3/76 |
-0.76 [-1.25, -0.27] |
0.56 |
2/62 |
-1.25 [-1.93, -0.56] |
0.28 |
|
DHA |
|
|
|
|
|
|
| ≤ 1300 mg/d |
4/266 |
-0.51 [-1.20, 0.19] |
|
4/266 |
-0.62 [-1.54, 0.29] |
|
| > 1300 mg/d |
3/76 |
-0.76 [-1.25, -0.27] |
0.56 |
2/62 |
-1.25 [-1.93, -0.56] |
0.28 |
|
EPA DHA ratio |
|
|
|
|
|
|
| ≤ 1 |
3/210 |
-0.80 [-1.53, -0.07] |
|
3/210 |
-0.88 [-2.20, 0.44] |
|
| > 1 |
4/132 |
-0.38 [-0.79, 0.03] |
0.32 |
3/118 |
-0.66 [-1.04, -0.29] |
0.76 |
|
Duration |
|
|
|
|
|
|
| ≤ 4 months |
5/168 |
-0.32 [-0.63, -0.01] |
|
4/154 |
-0.38 [-1.02, 0.26] |
|
| > 4 months |
2/174 |
-1.15 [-1.67, -0.62] |
0.008 |
2/174 |
-1.59 [-1.93, -1.25] |
0.001 |
|
Quality score |
|
|
|
|
|
|
| ≤ 3 |
5/299 |
-0.77 [-1.32, -0.22] |
|
4/285 |
-0.81 [-1.72, 0.10] |
|
| > 3 | 2/43 | -0.16 [-0.78, 0.46] | 0.15 | 2/43 | -0.80 [-1.45, -0.15] | 0.99 |
p※ difference between strata (Student’s t test).
TNF-α, tumor necrosis factor α; IL-6, interleukin 6; CHF, chronic heart failure; NYHA, New York Heart Association; LVEF, left ventricular ejection fraction; ACEI, angiotensin-converting enzyme inhibitor; ARB, angiotensin receptor inhibitor; EPA, eicosapentaenoic acid; DHA, ducosahexenoic acid; SMD, standardized mean difference; CI, confidence interval.